Question 7

41 year old female is admitted for dyspnea on exertion, myalgias and fatigue since last 6 months. She has a past history of rheumatoid arthritis for which she is regularly taking aspirin and a DMARD. She also has history of HTN treated with hydrochlorthiazide and DM controlled by diet. She smokes 1 pack of cigerette daily for last 20 years and consumes alcohol on weekends. Her father was diagnosed with CML and succumbed to it at the age of 65 years, and her mother died of old age. Her elder brother has psoariasis and elder sister has hashimotos thyroiditis. She is sexually active with her husband and uses condoms regularly. She did not travel anywhere out of her town for the last 3 years after she was diagnosed with Rheumatoid arthritis. She is a homemaker, and loves to be with her two lovely children. On examination her BP is 128/76 mm Hg and pulse of 110/min. She appears to be pale. Her CBC shows Hb of 9.2, MCV 120, and the peripheral smear is shown (Image Source: Google). She has no tingling or numbness of extremities. What is the cause of low Hb?

A) Reversible Myelosuppression
B) CML
C) B12 deficiency
D) Dietary Folate deficiency
E) Chemotherapy
F) Iron deficiency anemia
G) Bone marrow fibrosis
H) Irreversible Myelosuppression
I) Pernicious Anemia

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