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An 88-year-old woman with mild dementia, hypertension, gastroesophageal reflux disease, hypothyroidism, and osteoarthritis presents to her primary care physician for evaluation of an unsteady gait. She and her family have noticed gradual worsening of her gait over the past year. She denies dizziness or lightheadedness and she has no pain. She says that she is not interested in cooking any more and mostly eats toast with jam and drinks tea or coffee. Her medications include hydrochlorothiazide, levothyroxine, acetaminophen, aspirin, and pantoprazole. Her vital signs are unremarkable. Her examination is most notable for mild conjunctival pallor, decreased proprioception in the toes, and a positive Romberg’s sign. Laboratory tests reveal a hematocrit of 29% and mean corpuscular volume of 108 fL. A peripheral blood smear is shown in the image.
Which of her medications is most likely exacerbating her anemia?
A. Acetaminophen
B. Aspirin
C. Hydrochlorothiazide
D. Levothyroxine
E. Pantoprazole
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