A 94-year-old female nursing home resident is referred for evaluation of anemia of 8 g/dL. She has dementia, and adequate documentation of her past medical history is not available. She eats well and is cooperative. Examination reveals evidence of cognitive impairment, primitive reflexes, and a well-healed midline abdominal scar. Her blood film is shown in Figure below. You presume a relationship between the anemia and the previous surgery. Which of the following surgical procedures is most likely to cause her current anemia?
The macrocytic cells and hyper-segmented neutrophil are characteristic of megaloblastic anemia. Vitamin B12 and folate deficiency are the most common cause. Lack of intrinsic factor because of gastrectomy will eventually result in B12 deficiency.
gastrectomy
vagotomy and pyloroplasty
cholecystectomy
right hemicolectomy
G.I.T.