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24th July 2024
A 62-year-old female presents to her GP with fatigue, pallor and feeling more short of breath than usual on strenuous activity
A 62-year-old female presents to her GP with fatigue, pallor and feeling more short of breath than usual on strenuous activity. On examination, she appears to have mildly reduced sensation, which is worse in her feet than her hands, and complains of “pins and needles”. She has a background of type 1 (T1)DM on a basal-bolus insulin regimen as well as well-controlled hypothyroidism for which she takes 75 micrograms of levothyroxine daily. Her blood tests show:
| Hb (115 – 165 g/L) | 77 g/L |
| WCC (3.6 – 11.0 x 10⁹/L) | 6.1 x10⁹/L |
| Platelets (140 – 400 x10⁹/L) | 178 x10⁹/L |
| MCV (80 – 100 fL) | 118 fL |
| Film: | Oval macrocytes and hypersegmented neutrophils seen |
Abbreviation: WCC (white cell count)
Which investigation is most likely to find the underlying cause?
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