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What's the problem in this? Is there vit B12 deficiency

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iron deficiency anemia AND vitamin B12 deficiency

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Merck Manual microcytic anemia low MCV iron deficiency vitamin B12 macrocytic

The CBC suggests mild microcytosis, not vitamin B12 deficiency:
  • MCV 80.6 fL: low - red blood cells are smaller than usual
  • MCH 26.5 pg: low - cells carry slightly less hemoglobin
  • RDW 15.1%: high - red-cell sizes are variable
  • Hemoglobin 12.1 g/dL: normal - so there is no clear anemia yet
  • WBC and platelets are normal.
This pattern most often fits early iron deficiency, commonly due to low dietary iron or menstrual blood loss. Another possibility, especially if this pattern has been present for a long time or runs in the family, is thalassemia trait.
B12 deficiency is not suggested by this CBC. B12 deficiency classically causes large red blood cells, with an MCV usually above 100 fL, whereas yours is low. See Merck’s discussion of B12-related macrocytosis.
Recommended next tests:
  1. Serum ferritin - the most useful first test for iron stores
  2. Iron profile: serum iron, TIBC/transferrin saturation
  3. If ferritin is normal and microcytosis persists: Hb electrophoresis for thalassemia trait
  4. Serum B12 only if you have risk factors or symptoms such as vegan diet, metformin/acid-suppressant use, numbness/tingling, sore tongue, or memory/balance problems. A CBC alone cannot definitively rule B12 deficiency out, particularly if iron deficiency coexists.
Do not start high-dose iron indefinitely without confirming low ferritin, since thalassemia trait does not benefit from iron unless iron deficiency is also present.
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