A 40-year-old man, a known case of diabetes and on medication for the past 10 years comes to OPD with a history of abdominal pain, weakness, lightheadedness, palpitations and shoness of breath. On examination, glossitis along with hyperpigmentation of skin of dorsum of hands and feet and abnormal pigmentation of hair was observed. The family of the patient told that they have observed frequent episodes of increased irritability from the past 1 year. Given below are the laboratory findings and the peripheral blood smear. Later bone marrow aspiration was also done. Hb: 9gm% MCV: 110fl MCH: 36Pg MCHC: 34gm/dl Reticulocyte count: 0.1 x 10^9/L LDH: 600 U/L Indirect bilirubin: 1 mg/dL S. iron: Normal S. Ferritin: Normal WBC: 2 x 10^9/L Platelet count: 90 x 10^9/L PERIPHERAL BLOOD SMEAR BONE MARROW ASPIRATION Which of the following drugs is most likely the person is taking: -
This is a case of megaloblastic anemia due to Metformin intake. Lab findings show increased mcv, LDH, indirect bilirubin and normal iron studies, and low reticulocyte, WBC and platelet count. Pbs shows hypersegmented neutrophil. Bone marrow aspiration study shows megaloblasts. Metformin causes megaloblastic anemia as a side effect.
Metformin
Pioglitazone
Vildagliptin
Exenatide
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