A 30 year old female epileptic on phenytoin, developed weakness and fatigue. Blood examination revealed Hb = 4.6 gm. MCV = 102 fl and MCH = 40 pg/dl. What is the most probable diagnosis ?: (A) Hea failure, (B) Iron deficiency anaemia, (C) Phenytoin induced agranulocytosis, (D) Megalobalstic anaemia
Answer is D. Ans. is 'd' i.e., Megalablostic anaemia Raised MCV (normal 86-98) and MCH (normal 28-33) with low hemoglobin (normal 12-16) suggest the diagnosis of megaloblastic anemia. Remember Amongst antiepileptics, phenytoin, phenobarbitone and primidone can cause megaloblastic anemia.