<prompt> A 30 year old female epileptic on phenytoin, developed weakness and fatigue. Blood examination revealed Hb 4.6 gm. MCV 102 fl and MCH 40 pgdl. What is the most probable diagnosis ?Hea failureIron deficiency anaemiaPhenytoin induced agranulocytosisMegalobalstic anaemia  <response>: Ans. is d i.e., Megalablostic anaemia Raised MCV normal 86-98 and MCH normal 28-33 with low hemoglobin normal 12-16 suggest the diagnosis of megaloblastic anemia. Remember Amongst antiepileptics, phenytoin, phenobarbitone and primidone can cause megaloblastic anemia. 