مريضة عمرها ٦٠ سنة أجرت استئصال معدة كامل قبل ٣ سنوات، تشتكي من تعب وتنميل في القدمين وصعوبة توازن. لسانها أحمر أملس. الهيموغلوبين ٩٫٢، وحجم كريات الدم الحمراء كبير. ما السبب الأرجح؟

A 60-year-old woman who had a total gastrectomy 3 years ago reports fatigue, numb feet and poor balance. Her tongue is red and smooth. Hb 9.2 g/dL with large red cells. What is the likely cause?

1. Iron deficiency from hidden colonic bleeding
2. Vitamin B12 deficiency from absent intrinsic factor
3. Hypothyroidism caused by the operation
4. Vitamin C deficiency from eating little fruit

Answer: B) Vitamin B12 deficiency from absent intrinsic factor. The stomach makes intrinsic factor needed for B12 absorption. After gastrectomy, macrocytic anaemia with neurological symptoms develops, requiring lifelong B12 injections.