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Vitamin B12 deficiency — MCCQE Part 1 MCQ

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ModerateNumbness/TinglingVitamin B12 deficiencyMCCQE Part 1

A 68-year-old vegan man has fatigue, glossitis and numbness in both feet. Haemoglobin is 92 g/L, MCV is 112 fL and B12 is low. Which of the following is the most appropriate treatment?

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Correct answer: B — Vitamin B12 replacement and assessment of cause

Macrocytic anaemia with neuropathy and low B12 requires B12 replacement; neurological symptoms make timely treatment important. Folate alone can improve anaemia while allowing neurological injury to progress. The cause, including diet, pernicious anaemia or malabsorption, should be considered.

Reference: Canadian haematology practice; Choosing Wisely Canada laboratory medicine