Macrocytic normochromic anemia. Check B12 and folate levels and thyroid stimulating hormone.

Thyroid Stimulating Hormone Abnormal: Diagnosis - hypothyroidism.

B12 <160 pg/ml: Diagnosis - B12 deficiency.

Folate <2 ng/ml: Diagnosis - folic acid deficiency.

B12/folate Levels Normal: Check bone marrow biopsy - Normoblastic marrow or megaloblastic marrow.

Judith Harper, MD

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