[Solved]: Case One 31-year-old female presented with fatigue,…

Case One 31-year-old female presented with fatigue, which has been worsening over the past several months. Clinical History: The patient consumes a fifth of vodka every 2-3 days and admits that her diet typically does not include fruits, vegetables, legumes, fortified cereals, or bread. No family history of significance or medications. Upon physical exam, nothing of significance was noted. Initial Work-upCBCWBC Differential (%)WBC (X103/μL)3.3Neutrophils40RBC (X106/μL)1.05Bands0HGB (g/dL)4.8Lymphocytes59HCT %14Monocytes1MCV (fL)131Eosinophils0MCH (pg)45.7Basophils0MCHC (g/dL)34.3PLT (X103/μL)24RDW-CV29.6 Peripheral smear showed macrocytic red cells, marked anisocytosis, rare schistocytes, occasional spherocytes, minimal polychromasia, and occasional megaloblastic nucleated red blood cells. Occasional hypersegmented neutrophils and rare giant platelets were also present. Image A: Macroovalocytes and hypersegmented neutrophils Image B: Blue arrows show spherocytes and red arrows show schistocytes ChemistrySerum Vitamin B12 450 pg/mL200-1,000 pg/mLSerum folate 4 ng/mL5-20 ng/mL Bone marrow aspirate and biopsy showed markedly hypercellular marrow (90%) with marked erythroid hyperplasia and megaloblastic changes in both erythroid and myeloid lines. Image C: Erythroid hyperplasia and an arrow showing a giant band. What is this patient’s diagnosis? (0.5 points) Describe which information and values confirm this diagnosis (there is more than one)? (1.5 points) What would be the suggested treatment? (0.5 points) Case Two 58-year-old male presented with weakness and paresthesia’s of fingers and toes. Clinical History: The patient has a long history of schizophrenia, controlled with medication. He had poor eating habits, in part because of paranoia about certain foods. No family history of significance. Medications taken are Clozapine. Upon physical exam, the patient appeared underweight and was pale. He complained of difficulty walking and general weakness. Initial Work-upCBCWBC Differential (%)WBC (X103/μL)7.2Neutrophils64RBC (X106/μL)2.02Bands0HGB (g/dL)9.5Lymphocytes32HCT %29Monocytes3MCV (fL)142Eosinophils1MCHC (g/dL)33.2Basophils0PLT (X103/μL)91RDW-CV18.5 Peripheral smear showed macrocytic red cells, macroovalocytes, and hypersegmented neutrophils. Image A: Macroovalocytes and hypersegmented neutrophils ChemistrySerum Vitamin B12133 pg/mL200-1,100 pg/mLSerum folate12 ng/mL5-20 ng/mLMethymalonic Acid7.76 μmol/L0.00-4.00 μmol/L Bone marrow aspirate and biopsy showed giant bands, metamyelocytes, and megaloblastic and dyspoietic erythroid precursors. Image B: (a) macrocytic red blood cells and their progenitors, (b) giant band neutrophils, (c) hypersegmented neutrophils What is this patient’s diagnosis? (0.5 points) Describe which information and values confirm this diagnosis (there is more than one)? (1.5 points) What would be the suggested treatment? (0.5 points)