A patient complains of fatigue, lack of appetite, pain and burning sensation in the tongue, numbness of the distal limbs, diarrhea. Objectively: pale skin with lemon-yellow tint, face puffiness, brown pigmentation in the form of a "butterfly", bright red areas on the tongue. The liver is +3 cm below the costal margin, soft. Blood count: RBCs -1,5 × 1012/l, colour index -1,2, WBCs - 3,8 × 109/l, thrombocytes - 180 × 109/l, eosinophils - 0%, stab neutrophils - 1%, segmented neutrophils - 58%, lymphocytes - 38% monocytes - 3%, RBC macrocytosis. ESR - 28 mm/h. What diagnosis are these presentations typical for?

Answer options

1. Chronic adrenal failure
2. Iron deficiency anemia
3. Aplastic anemia
4. B12-deficiency anemia
5. Acute erythromyelosis

Explanation

A patient complains of fatigue, lack of appetite, pain and burning sensation in the tongue, numbness of the distal limbs, diarrhea. Objectively: pale skin with lemon-yellow tint, face puffiness, brown pigmentation in the form of a "butterfly", bright red areas on the tongue. The liver is 3 cm below the costal margin, soft. Blood count: RBCs -1, 5 • 1012/l, colour index -1,2, WBCs - 3,8109/l, thrombocytes - 180 109/l, eosinophiles - 0%, stab neutrophiles - 1%, segmented neutrophiles - 58%, lymphocytes - 38% monocytes - 3%, RBC macrocytosis. ESR - 28 mm/h.What diagnosis are these presentations typical for? Vitamin B12 deficiency anemia is a low red blood cell count due to a lack (deficiency) of vitamin B12. Vitamin B12 deficiency leads to Macrocytic, megaloblastic anemia; hypersegmentation PMNs; paresthesias, and subacute combined degeneration(degeneration of dorsal column, lateral corticospinal tract, and spinocerebellar tracts) due to abnormal myelin. Prolonged deficiency leads to irreversible nerve damage. Pernicious anemia is the most common cause of vitamin B12 deficiency.antibody to gastric parietal cell leads to the ineffective secretion of intrinsic factor (IF)leads to vitamin B12 deficiency due to decreased uptake in the terminal ileum. decrease uptake in the accompanied by achlorhydria and atrophic gastritisatrophic gastritis increases the risk of gastric cancer.color index higher than normal I.e < 1.0Symptoms can include:Diarrhea or constipationFatigue, lack of energy, or lightheadedness when standing up or with exertionLoss of appetitePale skinProblems concentratingShortness of breath, mostly during exerciseSwollen, red tongue, or bleeding gums Symptoms of nerve damage include:Confusion or change in mental status (dementia) in severe casesDepressionLoss of balanceNumbness and tingling of hands and feet