A 54-Year-Old Man Comes to the Office Due to Several

A 54-year-old man comes to the office due to several months of increased fatigability.  He drinks 2-3 cans of beer on the weekends and rarely eats meat.  Physical examination reveals pale conjunctivae and hyperdynamic carotid pulses.  Hemoglobin level is 7.7 g/dL, leukocytes are 4,500/mm³, and platelets are 170,000/mm³.  Folic acid therapy is initiated.  Four weeks later the patient's hemoglobin level is 9.1 mg/dL, but he has new tingling in his toes.  Which of the following is a likely cause of this patient's current symptoms?

A) Drug toxicity
B) Iron deficiency
C) Vitamin deficiency
D) Glucose intolerance
E) Extramedullary hematopoiesis
F) Autoimmune hemolysis
G) Factitious disorder

Correct Answer:

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