Approach to anemia (underproduction) Quiz: Ace Your Exams
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A 41-year-old woman presents to the primary care clinic with fatigue and headaches for five months. She struggles with having enough energy to teach her preschool students and has noticed numbness in her feet for the past four weeks. Temperature is 37.2°C (99°F), pulse is 83/min, respiratory rate is 14/min, and blood pressure is 123/74 mmHg. On physical examination, she appears pale with mild conjunctival pallor. Strength is 5/5 in all extremities with decreased sensation to light touch in both feet. Cardiopulmonary and abdominal examinations are unremarkable. Initial laboratory studies reveal a normal basic metabolic panel and thyroid stimulating hormone. Results from a complete blood count and additional studies are shown below. Which of the following additional clinical elements is most likely to be present?
| Laboratory value | Result |
| Hemoglobin | 10.6 g/dL |
| Hematocrit | 32% |
| Mean corpuscular volume | 102 fL |
| Reticulocyte count | 1.0% |
| Peripheral blood smear | Macrocytosis and hypersegmented neutrophils |
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