Question

A software engineer presented to OPD with complaints of easy fatiguability. He gives a history of sitting in front of the computer for 12-14 hrs a day and consuming junk food and less fruits and vegetables. CBC picture showed Hb concentration as 7gm%, MCV-120. What is the most likely cause of anemia?

• A. Folate deficiency
• B. Sideroblastic anemia
• C. Cyanocobalamin deficiency
• D. Acute blood loss

Hint:

A high MCV with dietary deficiency of fruits and vegetables points to megaloblastic anaemia from a vitamin found in green leafy foods.

Answer 1

The Correct Option is A

Step 1: Interpret the CBC findings.
MCV of 120 fL indicates macrocytic anaemia (normal MCV: 80-100 fL). This narrows the diagnosis to either folate deficiency or vitamin B12 (cyanocobalamin) deficiency, both of which cause megaloblastic macrocytic anaemia.

Step 2: Analyse the dietary history.
The patient consumes junk food with less fruits and vegetables. Folate is found abundantly in green leafy vegetables, citrus fruits, and legumes. A diet poor in fruits and vegetables is the most common cause of folate deficiency. The body's folate stores are relatively small (3-4 months), so deficiency develops quickly with poor dietary intake.

Step 3: Why not B12 (cyanocobalamin) deficiency?
Vitamin B12 is found in animal products. A software engineer consuming junk food (which typically includes animal-based fast foods) is unlikely to be purely B12-deficient. Also, B12 stores last 3-5 years, making dietary B12 deficiency less likely to manifest over a short period. The sedentary lifestyle with poor fruit/vegetable intake strongly points to folate deficiency.

Step 4: Rule out other options.

• Sideroblastic anaemia: Typically normocytic or mildly macrocytic; not classically MCV 120.
• Acute blood loss: Causes normocytic anaemia, not macrocytic. MCV would be normal.

Conclusion: Folate deficiency is the most likely cause.