A young female patient presented with symptoms related to anemia. Peripheral blood smear showed neutrophil hypersegmentation and bone marrow aspirate smear showed giant myelocytes. Which of the following is the likely etiology?

Both the above mentioned findings are features of megaloblastic anemia. Folic acid deficiency is one of the causes of megaloblastic anemia. Ceain peripheral blood findings are common to all forms of megaloblastic anemia: Macrocytic red cells which may lack central pallor Macro-ovalocytes Low reticulocyte count Neutrophils are also larger than normal and show nuclear hypersegmentation, having 5 or more nuclear lobules instead of the normal 3-4 The marrow is hypercellular with megaloblastic changes detected at all stages of erythroid development. As DNA synthesis is impaired in all proliferating cells, granulocytic precursors also display dysmaturation in the form of giant metamyelocytes and band forms.