NBME 24 Answers : Block 2 : #1 = A 73-year-old woman has had easy fatigability for 2 ...

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submitted by lispectedwumbologist(23),

Why would it not be anemia of chronic disease with decreased serum transferrin concentration?

lispectedwumbologist Nevermind I'm stupid as fuck I see my mistake +

drdoom be kind to yourself, doc! (it's a long road we're on!) +7

step1forthewin Hi, can someone explain the blood smear? isn't it supposed to show hypersegmented neutrophils if it was B12 deficiency? +

loftybirdman I think the blood smear is showing a lone lymphocyte, which should be the same size as a normal RBC. You can see the RBCs in this smear are bigger than that ->macrocytic ->B12 deficiency +8

seagull maybe i'm new to the game. but isn't the answer folate deficiency and not B12? Also, i though it was anemia of chronic disease as well. +

vshummy Lispectedwumbologist, please explain your mistake? Lol because that seems like a respectible answer to me... +

gonyyong It's a B12 deficiency Ileum is where B12 is reabsorbed, folate is jejunum The blood smear is showing enlarged RBCs Methionine synthase does this conversion, using cofactor B12 +

uslme123 Anemia of chronic disease is a microcytic anemia -- I believe this is why they put a lymphocyte on the side -- so we could see that it was a macrocytic anemia. +

yotsubato Thanks NBME, that really helped me.... +

keshvi the question was relatively easy, but the picture was so misguiding i felt! i thought it looked like microcytic RBCs. I guess the key is, that they clearly mentioned distal ileum. and that is THE site for B12 absorption. +2

sahusema I didn't even register that was a lymphocyte. I thought I was seeing target cells so I was confused AF +