A middle aged chronic alcoholic man complains of burning sensation in the mouth. On examination he has thickened, dry, smooth tongue with absence of the filliform papillae. MCV is 100. Which of the following should be first line of approach in the management of this patient?

The above given scenario is likely a case of Vitamin B12 deficiency hence estimation of Vitamin B12 levels should be the first step in management. Its deficiency may cause a bilateral peripheral neuropathy or degeneration (demyelination) of the cervical and thoracic posterior and lateral (pyramidal) tracts of the spinal cord. Other clinical features include: Anorexia - weight loss Diarrhea or constipation. Glossitis Angular cheilosis Jaundice (unconjugated) Reversible melanin skin hyperpigmentation Thrombocytopenia The anemia and low leukocyte count may predispose to infections, paicularly of the respiratory and urinary tracts. Glossitis