hemonq17 - spartans1

[ArchivalUser]

78 y/o woman is evaluated for increasing forgetfulness. The problem has been slowly progressive over the past 7 months. She is able to live independently and has not had difficulties with ADL. The remainder of the hx and exam are non contributory.

Hgb=7.8g/dl, WBC= 3800/ul, MCV=110, Plt=127,000.

LDH=565, Dbili=0.3, Tbili=4.8, B12=325pg/ml, Folate=12ng/ml, Homocysteine=2.57 mg/l, Methylmalonic acid=400nmol/L


Which of the following is the most likely diagnosis?


A. Folate Deficiency
B. Vitamin B12 deficiency
C Autoimmune Hemolytic Anemia
D. Myelodysplasia

[ArchivalUser]

Laboratory Studies
Hemoglobin:7.8 g/dL (78 g/L)

Leukocyte count:3800/μL (3.8 — 109/L)

Mean corpuscular volume:110 fL

Platelet count:127,000/μL (127 — 109/L)

Serum lactate dehydrogenase:565 U/L

Serum direct bilirubin:0.3 mg/dL (5.13 mol/L)

Serum total bilirubin:4.8 mg/dL (82.08 mol/L)

Serum vitamin B12:325 pg/mL (239.85 pmol/L)

Serum folate:12 ng/mL (27.19 nmol/L)

Serum homocysteine:2.57 mg/L (19 Îmol/L)

Serum methylmalonic acid :400 nmol/L

[ArchivalUser]

i feeel D

[ArchivalUser]

BBB...?

[ArchivalUser]

B......??

[ArchivalUser]

Serum homocysteine:2.57 mg/L (19 Îmol/L)

Serum methylmalonic acid :400 nmol/L

[ArchivalUser]

high homocysteine,high normal methylmalonic acid,
neuropathy ....i still think.......B

[ArchivalUser]

and folate is in normal range........DOC

[ArchivalUser]

bbb

[ArchivalUser]

option b ,but the blood levels are normal....mcv is high