A 26 years old female presented with pallor and hemoglobin of 9.5 mg/dl, PCV 30 mm Hg and RBC count of 2 million/mm. What is the most likely diagnosis?
Iron deficiency anemia
Sideroblastic anemia
Thalassemia
Folic acid deficiency
Ans: D. Folic acid deficiency(Ref Robbins 9/e p631, 648)High MCV, MCH & MCHC - Suggestive of macrocytic, hyperchromic anemia.Typically seen in folic acid deficiency.Folic acid (pteroylmono- glutamic acid) deficiency a results in megaloblastic anemia.Same pathologic features as vitamin B12 deficiency.Interpretation:In question, Hb= 9.5 mg/dL, PCV = 30, RBC count = 2 millions/mm3Hematocrit or PCV = MCV x RBC concentrationMCV PCV/RBC count = 30/0.2 = 150 (increased/Macrocytic)MCH = Hb/ RBC count =9.5/0.2 = 47.5 (increased/Hyperchromic)MCHC = Hb/MCV = 31 (normal)Macrocytic, hyperchromic anemia is typically seen in folic acid deficiency.