Step 2

Hematology 10

A 65-year-old man presents to the clinic with complaints of fatigue, difficulty walking, and memory problems that have been progressively worsening over the past 6 months. He also reports numbness and tingling in his hands and feet. His past medical history is significant for type 2 diabetes which is managed with metformin. He lives alone and has a history of alcohol use, consuming approximately 3-4 drinks per day for the past 20 years. His vital signs are: temperature 98.4°F (36.9°C), heart rate 88 beats/minute, blood pressure 130/78 mmHg, and respirations 16/minute. Neurological examination reveals decreased vibration and position sense in his lower extremities, and his gait is ataxic. Laboratory tests reveal a hemoglobin A1c of 6.8%, a hemoglobin level of 10.2 g/dL, and a mean corpuscular volume (MCV) of 110 fL. Further testing shows elevated methylmalonic acid and homocysteine levels.

Which of the following is the most likely diagnosis?

  • A) Folate deficiency
  • B) Iron deficiency anemia
  • C) Sideroblastic anemia
  • D) Thalassemia minor
  • E) Vitamin B12 deficiency

Author(s)

Dr. Ted O'Connell

Editor(s)

Dr. Ted O'Connell

Last updated

Mar 24, 2025

Our Other Products: