A 9-month-old exclusively breastfed infant of a strict vegan mother presents with pallor, lethargy, developmental regression, and involuntary movements. Haemogram shows macrocytic anaemia with hypersegmented neutrophils and low reticulocyte count. The most likely deficiency is:

• A Vitamin B12 ✓
• B Folate
• C Iron
• D Thiamine

Explanation

Breastfed infants of vegan mothers develop vitamin B12 deficiency because maternal stores are depleted and breast milk contains little B12. The picture combines megaloblastic anaemia with neurological signs such as regression and tremors. Maternal dietary folate is usually adequate from vegetables, so isolated folate deficiency is unlikely here, and iron deficiency would produce a microcytic rather than macrocytic blood film.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.