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6th February 2024

A 50-year-old woman presents to the clinic with chronic tiredness.

A 50-year-old woman presents to the clinic with chronic tiredness. She has a history of chronic kidney disease, rheumatoid arthritis and ischaemic heart disease. 

Her investigations show the following:
Hb 78 g/L (Normal 115-165 g/L)
MCV 102 (Normal 80-100fL)
Ferritin 180 (Normal 10-300 ng/ml)
Folate 0.2 nmol/L
Vitamin B12 623 ng/L
TSH 4.80 mU/L

What medication would be the most likely cause of her anaemia?

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