An adult strict vegetarian presents with macrocytic anemia and hypersegmented neutrophils. Serum methylmalonic acid is normal but homocysteine is elevated. Which vitamin deficiency is most likely?
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Correct answer: Vitamin B9 (folate)
Folate (vitamin B9) deficiency causes megaloblastic anemia with elevated homocysteine but normal methylmalonic acid, distinguishing it from B12 deficiency.
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