Question:medium
A 50-year-old man presents with paresthesia. Hemoglobin is 6.8 g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. The most probable diagnosis is:
A 50-year-old man presents with paresthesia. Hemoglobin is 6.8 g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. The most probable diagnosis is:
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Megaloblastic picture with neuropathy and atrophic gastritis narrows it to one vitamin.
Updated On: Jun 23, 2026
- Folate deficiency
- Vitamin B12 deficiency
- Riboflavin deficiency
- Iron deficiency
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The Correct Option is B
Solution and Explanation
Work through the options. Iron deficiency causes a microcytic, hypochromic anemia, the opposite of the macrocytosis seen here, so it is out. Riboflavin deficiency does not give this blood picture. That leaves the two megaloblastic causes, folate and B12, both of which produce macrocytosis with hypersegmented neutrophils. The tiebreakers are decisive: the paresthesia signals neurological damage from subacute combined degeneration, which folate deficiency does not cause, and the atrophic gastritis means loss of intrinsic factor and failed B12 absorption. Both findings point squarely at vitamin B12 deficiency, which is the most probable diagnosis.
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