What is the most likely explanation for this patient’s anemia
Ongoing microscopic blood loss
Incorrect, try again! Since the patient has normal CRP and fecal calprotectin, and no evidence of active disease was identified at her recent colonoscopy, it is unlikely she has microscopic gastrointestinal bleeding
Impaired B 12 absorption
Correct! Vitamin B 12 bound to intrinsic factor is reabsorbed in the terminal ileum. In patients who have undergone a terminal ileum resection, there is impaired absorption of Vitamin B 12. These patients usually require IM or intranasal B 12 supplementation as oral B 12 supplements are not absorbed.
Impaired iron absorption
Try again! Iron is absorbed in the duodenum, so the patient has no reason to have impaired iron absorption.
Folic acid deficiency
Incorrect, try again!Folic acid is present in green leafy vegetables. If the patient is eating a balanced diet, folate deficiency would be extremely unlikely . Patients who have undergone bariatric surgery, who those with severe malnutrition, chronic alcohol use or chronic hemolytic anemia are specifically at risk for folate deficiency. This patient does not have any of these specific risk factors
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