The CBC shows severe macrocytic anemia, most likely a megaloblastic anemia caused by vitamin B12 deficiency and/or folate deficiency.

Key findings:

This report alone cannot distinguish B12 deficiency from folate deficiency, or exclude other causes such as hypothyroidism, liver disease, alcohol use, medications, hemolysis, or less commonly bone-marrow disorders. The usual next tests are peripheral smear, reticulocyte count, serum vitamin B12, folate, bilirubin/LDH, thyroid and liver tests. Macro-ovalocytes and hypersegmented neutrophils on smear support megaloblastic anemia, as described in the MSD diagnostic guidance.

This needs urgent in-person medical assessment today. A hemoglobin of 4.4 g/dL can cause dangerous reduced oxygen delivery and may require hospital treatment, including consideration of blood transfusion depending on symptoms and examination. Go to an emergency department now if there is breathlessness, chest pain, fainting, palpitations, severe weakness, confusion, or active bleeding.

Do not start folic acid alone before B12 is assessed or treated, because it can improve the anemia while allowing B12-related nerve damage to progress.