Macrocytic anemia may be seen with all of the following conditions ckccpt :

Answer is B (Copper deficiency) Cu deficiency has not been mentioned to cause megaloblastic picture. It causes a normocytic hypochromic picture. Orotic acid is an intermediate metabolite in the synthesis of pyrimidines. Orototic aciduria is a rare disorder in children, resulting from block of fuher metabolism of orotic acid. Affected children have megaloblastic anemia that is unresponsive to Vit C, Vit B12 and folic acid. Thiamine deficiency may be associated with 'thiamine responsive anemia'. In the untreated state this gives rise to a megaloblastic anemia. - Liver disease may give rise to megaloblastic anemia, by interferring with storage and metabolism of fat soluble vitamin B Causes of Macrocytic anemia Vit. Bit deficiency Folic acid deficiency Orotic aciduria Nitrous oxide inhalation Liver disease Hypothyroidism Thiamine deficiency