A 64-year-old patient, known vegetarian, diabetic and hypertensive, had presented to
antibiotics, hydration and analgesia. Routine labs showed Anemia with reticulocytosis, emergency with jaundice and acute calculus cholecystitis. The patient was stabilized with neuropathy with
normal morphology of neutrophils, mild megaloblastosis with acanthocytosis, and elevated
LDH levels. Emergency cholecystectomy was done. Biopsy showed hemolytic brown stones in the gall bladder. The patient also has complaints of peripheral
numbness and tingling in the glove and stocking pattern. He also had a history of chronic
pancreatitis and steatorrhoea.
Which vitamin is most likely to be deficient