Volume 29, Issue 3 (1-2023)
Intern Med Today 2023, 29(3): 0-0 |
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Bakhtiari Shahri A, Tavakolizadeh M. Severe Vitamin B12 Deficiency Resulting in Severe Pancytopenia: A Case Report. Intern Med Today 2023; 29 (3)
URL: http://imtj.gmu.ac.ir/article-1-4054-en.html
URL: http://imtj.gmu.ac.ir/article-1-4054-en.html
1- Associated Professor of Internal Medicine, Faculty of Medicine, Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran.
2- Master of Science in Medical-Surgical Nursing, Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran ,tavakolizadeh.m@gmu.ac.ir
2- Master of Science in Medical-Surgical Nursing, Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran ,
Abstract: (88 Views)
Background and Aims: This case report aims to highlight a rare presentation of severe vitamin B12 deficiency resulting in severe pancytopenia in an elderly male patient, occurring in only 5% of patients with known B12 deficiency. Additionally, it discusses the hematological changes associated with B12 deficiency and how they can sometimes mimic hematological malignancies.
Patient Profile: The patient was an 86-year-old man from a rural area with a history of generalized weakness and jaundice. He had no significant past medical history besides prior pneumonia and cataract surgery. He presented with symptoms of anorexia, dizziness, and nausea but no fever. He was not a smoker, drinker, or drug user. The patient was living with his children and seemed to be economically disadvantaged.
Findings: Initial examination revealed icteric sclera, pale conjunctiva, and 1+ edema in both lower limbs. Initial lab tests indicated increasing MCV, and peripheral blood smear showed hypersegmented neutrophils, macroovalocytes, anisocytosis, as well as possible RBC agglutination and schistocytes. The patient was diagnosed with megaloblastic anemia and started on high-dose vitamin B12 and folate. The patient's condition deteriorated, with a drop in platelet and WBC counts and the presence of schistocytes, leading to a bone marrow biopsy, which suggested MDS or AML-M6; however, further tests indicated a nutritional deficiency. The patient improved significantly with high-dose B12 and folate treatment, and blood counts normalized.
Conclusion: The present case demonstrates that severe vitamin B12 deficiency can manifest as severe pancytopenia and that it can be mistaken for acute leukemia or other hematological malignancies.
Patient Profile: The patient was an 86-year-old man from a rural area with a history of generalized weakness and jaundice. He had no significant past medical history besides prior pneumonia and cataract surgery. He presented with symptoms of anorexia, dizziness, and nausea but no fever. He was not a smoker, drinker, or drug user. The patient was living with his children and seemed to be economically disadvantaged.
Findings: Initial examination revealed icteric sclera, pale conjunctiva, and 1+ edema in both lower limbs. Initial lab tests indicated increasing MCV, and peripheral blood smear showed hypersegmented neutrophils, macroovalocytes, anisocytosis, as well as possible RBC agglutination and schistocytes. The patient was diagnosed with megaloblastic anemia and started on high-dose vitamin B12 and folate. The patient's condition deteriorated, with a drop in platelet and WBC counts and the presence of schistocytes, leading to a bone marrow biopsy, which suggested MDS or AML-M6; however, further tests indicated a nutritional deficiency. The patient improved significantly with high-dose B12 and folate treatment, and blood counts normalized.
Conclusion: The present case demonstrates that severe vitamin B12 deficiency can manifest as severe pancytopenia and that it can be mistaken for acute leukemia or other hematological malignancies.
Type of Study: Case report |
Subject:
Internal Medicine
Received: 2024/09/30 | Accepted: 2025/03/1 | Published: 2023/01/1
Received: 2024/09/30 | Accepted: 2025/03/1 | Published: 2023/01/1
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