This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Macrocytic anemia occurs in all except 
Select and explain. 
A. Thiamine deficiency, B. Liver disease, C. Orotic aciduria, D. Copper deficiency
D: Copper deficiency
Answer: D: Copper deficiency 
Explanation: Copper - containing ceruloplasmin helps in iron transport. Copper is an integral part if ALA synthase enzyme which is used in haem synthesis.
Copper helps the uptake of iron by normoblasts. Thus in copper deficiency, RBC count is reduced, cell size is small but hemoglobin concentration is more or less normal.
So it results in microcytic normochromic anemia.