Question about Pathophysiology and Anemia

Question

A 65-year-old woman is seen in the clinic because of numbness in her lower legs and feet and difficulty walking. She has no other complaints. She takes a blood pressure pill, two calcium pills, and a multivitamin daily. Her laboratory results include RBC count of 3.0 x 106/µL, hemoglobin 9g/dL, hematocrit of 20%, and a markedly elevated MCV. 

1. What type of anemia does she have? (I'm assuming Pernicious anemia caused by a vitamin B12 deficiency... is this correct?)
2. What is the reason for her neurologic symptoms? I already know about how a lack of vitamin B12 affects the nervous system, I'm mostly wondering if the BP pill, calcium pills, and multivitamin pill could be contributing to these symptoms, and if so, how.

Thanks so much for any help! :)

Answer 1

Yes, B12 deficiency is a common cause of macrocytic anemia. Other causes include folate deficiency, alcoholism, hyothyroidism, certain drugs (not BP meds nor calcium), and myelodysplastic syndrome. Of these B12 and folate deficiency, hyopothyroidism and alcohol can also cause neuropathy. We can assume that it is not folate deficiency as she is on a multivitamin and folate is readily absorbed. Similarly, we can assume this is not a dietary B12 deficiency because she is presumable getting B12 in the multivitamin. So pernicious anemia is more likely. Hypothyoidism and alchohol cannot be excluded by the history as given.