Family Nurse Practitioner Exam

For an older diabetic male with macrocytic anemia, which test is most appropriate to identify potential deficiencies?

1. Serum ferritin and a peripheral smear

2. Hemoglobin electrophoresis

3. Serum folate acid and B12 level

4. Schilling test

The correct answer is: Serum folate acid and B12 level

In the context of an older diabetic male presenting with macrocytic anemia, assessing for potential deficiencies in vitamin B12 and folate is essential. Macrocytic anemia, characterized by larger than normal red blood cells, can arise from several nutritional deficiencies, most notably vitamin B12 and folate. Both of these vitamins are crucial for DNA synthesis in red blood cell production, and deficiencies can lead to the impaired maturation of these cells, resulting in macrocytic anemia. Serum folate and B12 levels are direct tests that can definitively indicate whether deficiencies in these vitamins are contributing to the patient's macrocytic anemia. If the levels of either of these vitamins are found to be low, appropriate supplementation or dietary changes can be initiated to address the deficiency and, consequently, the macrocytic anemia. In contrast, while serum ferritin and a peripheral smear might provide insights into iron status and overall cell morphology, they do not directly evaluate for the specific deficiencies most pertinent to macrocytic anemia. Similarly, hemoglobin electrophoresis primarily focuses on identifying hemoglobin variants and disorders rather than addressing nutritional deficiencies. The Schilling test, once a standard for assessing vitamin B12 absorption, is now rarely used in clinical practice and does not apply to the immediate