Q:

A 45 year old woman undergoing treatment for RA for the last 5yrs presents with dizziness, easy fatigabiliy and lack of energy. A blood film shows MCV 106. What could be the most probable reason for her anemia?

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A 45 year old woman undergoing treatment for RA for the last 5yrs presents with dizziness, easy fatigabiliy and lack of energy. A blood film shows MCV 106. What could be the most probable reason for her anemia?


  1. Steroids
  2. Chronic disease
  3. NSAIDs
  4. Methotrexate
  5. Sulfasalazine

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The key is D. Methotrexate. [Methotrexate is used as DMARDs (disease modifying anti rheumatic

drugs) in rheumatoid arthritis to slow the disease progression which leads to folate deficiency anaemia].

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