A 30-year old epileptic female, Kamla on Phenytoin therapy, 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 anemia, (C) Phenytoin induced agranulocytosis, (D) Megaloblastic anemia
Answer is D. Phenytoin can cause folic acid deficiency resulting in megaloblastic anemia. This is confirmed by raised MCV and MCH in the blood examination. REF: KD TRipathi 8th ed.