Endocrine including hypothyroidism. Vitamin B 12 deficiency. Symptoms of anemia. Neurologic disease may occur with normal hematocrit. Signs and symptoms are the same as in vitamin B 12 deficiency, except that the patient is more likely to be malnourished.
Neurologic abnormalities are generally absent as is glossitis.
Elevated MCV, low reticulocyte count. However, many have normal indices because of coexistent thalassemia or iron deficiency, etc. Serum folate level varies with meals and is an unreliable indicator of base state. Smear shows anisocytosis, poikilocytosis, basophilic stippling, hypersegmentation of neutrophils. Once the diagnosis of vitamin B 12 deficiency is made, a Schilling test can identify the pathophysiologic characteristics.