A patient has Hb 82 g/L, ferritin 7 micrograms/L, vitamin B12 80 pmol/L, MCV 96 fL and a dimorphic film. There is no haemodynamic instability or

Question

A patient has Hb 82 g/L, ferritin 7 micrograms/L, vitamin B12 80 pmol/L, MCV 96 fL and a dimorphic film. There is no haemodynamic instability or neurological deficit. What is the best interpretation and initial plan?

Accepted Answer

Treat both iron and B12 deficiency while investigating a unifying malabsorptive or bleeding cause

Answer

Treat iron alone because low ferritin makes the measured B12 result analytically irrelevant

Answer

Diagnose myelodysplasia without correcting documented nutrient deficiencies or reassessing the film

Answer

Exclude both deficiencies because a normal MCV has adequate sensitivity for each disorder

Answer

Treat B12 alone because macrocytes always dominate MCV when dual deficiency is present

Combined Iron and B12 Deficiency — RACP Adult Medicine MCQ

A patient has Hb 82 g/L, ferritin 7 micrograms/L, vitamin B12 80 pmol/L, MCV 96 fL and a dimorphic film. There is no haemodynamic instability or neurological deficit. What is the best interpretation and initial plan?