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Keywords: severe anemia, thrombocytopenia, severe neutropenia, megaloblastic, hypercellular bone marrow, myelodysplastic syndrome mimic, bone marrow biopsy, vit b12 deficiency, myelodysplastic syndrome (mds), pancytopenia Introduction Vitamin B12 deficiency is a common condition estimated to be present in 3.6% of all adults over the age of 18 years that often presents with fatigue caused by macrocytic anemia [1]