A 72-yeаr-оld femаle presents with fаtigue, dyspnea, and angina. Physical examinatiоn reveals pale cоnjunctiva, a grade 2 pulmonary flow murmur, glossitis, and decreased vibration sense in the lower extremities. CBC shows macrocytic indices, pancytopenia with macro-ovalocytes and hypersegmented neutrophils. Reticulocyte count is less than 2%. Which of the following is the most likely diagnosis?
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