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A 47-year-old woman presents to your office complaining of tongue soreness, fatigue, and dyspnea with exertion. She denies unusual bleeding, weight loss, fevers, and night sweats. Her past medical history includes hypothyroidism, for which she takes levothyroxine, and she does not drink alcohol or smoke. Physical exam reveals a tired-appearing woman with lemon-yellow colored skin, temperature 37 C, pulse 110, blood pressure 120/74, and respirations 12. The exam is otherwise unremarkable. A CBC demonstrates a WBC count 4,000/mm3, hemoglobin 9 g/dl, platelet count 140,000/mm3, and a MCV of 105 fl. Her B12 level is 100 pg/ml (normal > 300pg/ml) and folate 40 ng/ml.