A 55-year-old male consulted his physician because of weakness, lightheadedness, vertigo, and angina. The patient also complained of sores on his tongue. The physical examination revealed jaundice
The pulse rate was increased, and the spleen and liver were slightly enlarged. The tongue appeared smooth and bright red in color. Family history revealed no clues. Neurological exam revealed quickening of reflex responses. Patient history indicated a total gastrectomy five years earlier for stomach cancer and intermittent heart problems that had not required surgery. The physician ordered the following tests:
TEST RESULTS
WBC 3.1 x 109/L
RBC 2.45 x 1012/L
HGB 10.5 gm/dL
HCT 29.0%
MCV 118 fl
MCH 42.8 pg
MCHC 36.2 gm/dL
RDW 15.7
PLT 83 x 109/L
Differential:
Polys 49%
Stabs 6%
Lymphs 30%
Mono 8%
Eos 5%
Basos 2%
Peripheral blood: macro-ovalocytes, no hypersegmentation noted.
What would be the results of vitamin B12 and/or folate levels in a diagnosis of pernicious anemia?
a. Increased folate
b. Increased vitamin B12
c. Decreased vitamin B12
d. Decreased folate and vitamin B12
Correct Answer: C
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