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Keywords: Acute leukemia, megaloblastic anemia, myelodysplastic syndrome, pancytopenia, vitamin B12 deficiency Early identification and prompt treatment of vitamin B12 deficiency is of utmost importance, because it is a reversible cause of ineffective hematopoiesis, 1 in contrast to myelodysplastic syndrome or acute myeloid leukemia, which are irreversible disorders of ineffective hematopoiesis