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A 58 yr-old man with an ST-elevation MI was evaluated for macrocytic anemia, elevated indirect bilirrubin and LDH , and thrombocytopenia. Peripheral blood smear revealed the presence of marked anisocytosis and poikilocytosis, macroovalocytes, scatered schistocytes, microcytes and frequent RBCs with Cabot Rings. Vitamin B12 leves were <150 pg/mL (193-982 pg/mL). After supplementation, the abnormalities resolved.