10:38 PM:

Case study
Patient
58 year old

CC
The patient presented to her physician because of tiredness and fatigue of several months duration, which was increasing in severity. She also complained of tingling and numbness in her feet and legs for the past 3 -4 weeks.

Medical History
The patient has been previously healthy, except for an appendectomy at age 18.

Drug history
No medications

Physical examination
The patient was pale and her skin had a sallow appearance. Neurologic exam revealed diminished vibratory sense and decreased sensation in the lower extremities.



Blood Film examination
Decreased red cells with marked anisopoikilcytosis and numerous oval macrocytes. Frequent hypersegmented neutrophils.

Questions to ask
What is the most likely diagnosis in this patient ?
How do the presenting clinical features relate to the diagnosis ?
How should this patient be treated ?


Diagnosis
Pernicious anemia