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

Stepwise differential diagnosis for macrocytic anaemia:

Given data: Hb = 7 gm%, MCV = 120 fL, diet poor in fruits & vegetables, sedentary lifestyle.

MCV > 100 fL = Macrocytic anaemia. The two main nutritional causes are:

• $\textit{Folate deficiency}$: Stores last ~3-4 months. Found in green leafy vegetables and fruits. A diet of junk food (lacking fresh produce) rapidly depletes folate stores.
• $\textit{Vitamin B12 deficiency}$: Stores last 3-5 years. Found in animal products. Unlikely to be deficient in someone eating junk food (which contains animal products).

The key discriminator here is the dietary history: junk food lacking fruits and vegetables = depleted folate, not B12.

Other options eliminated:

• Sideroblastic anaemia: microcytic or normocytic, not macrocytic
• Acute blood loss: normocytic (MCV normal), not macrocytic

\[\boxed{\text{Folate deficiency (Option A)}}\]