What are the evidences that may lead you to consider B12 deficiency anaemia as a diagnosis?

Scenario:
Raya is a gray-haired 58-year-old lady, admitted to the hospital through A&E.
She claimed that she had fallen over and bruised herself. On examination she appeared pale, confused, has yellow skin, inflamed tongue. She also has paraesthesia of feet and fingers. Raya had past history of heart failure. Her medications include frusemide and amiloride. She is diagnosed as having macrocytic anaemia.
Laboratory tests revealed the following:
RBCs — Macrocytic normochromic
MCV — 180 µm3
Folate — 160 mg/l (160 – 640 mg/l).
B12 — 70 (110-1500 pg/mL)
Questions:
• Apply SOAP module to this scenario.
• State the causes of B12 deficiency anaemia.
• What are the evidences that may lead you to consider B12 deficiency anaemia as a diagnosis?
• Can Raya have a blood transfusion after samples have been taken for folate and B12 levels?

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