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Although tests for both anti-parietal cell and anti-intrinsic factor antibodies were negative, we could not rule out pernicious anemia because of the modest test sensitivity of these antibody assays (90% and 60%, respectively).5 Hematologic manifestations of vitamin B 12 deficiency include megaloblastic anemia with macrocytic red blood cells and hypersegmented neutrophils, as seen in our patient (Figure 1)