I. HISTORY

PATIENT PRESENTATION

A 78-year-old Caucasian woman is being seen by her physician due to a macrocytosis of her red cell indices. She is noted to have an increasing mean corpuscular volume (MCV) from 99 to 103 in the past year. The patient complains of feeling tired during the day and of sleeping more than she did in the past.

Medical History: She has been treated for hypertension and chronic obstructive pulmonary disease for the past several years. Her only medication is verapamil for hypertension. She is status post vagotomy and pyloroplasty for a duodenal ulcer.

Social History: The patient is a retired office worker. She lives alone in her apartment. She was never married and has no children. She quit smoking 30 years ago and denies any alcohol intake.

Family History: There is no history of anemia.

Review of Systems: Unremarkable.

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