Severe Haemolytic Anaemia, a Rare Presentation of Nutritional Vitamin B12 Deficiency: A Case Report

Aamir Siddiqui

doi:10.3126/nmj.v2i1.24556

Abstract

Vitamin B12 deficiency usually presents with megaloblastic anemia, pancytopenia, and neurological symptoms. The cause is usually, nutritional deficiency, increase demand, decrease absorption. This report describes a case with symptoms of apathy and findings suggestive of severe hemolytic anemia, diagnosed with vitamin B12 deficiency. Haemolysis is a rare hematological finding in cases of B12 deficiency, and descriptions of a nutritional vitamin B12 deficiency, without evidence of pernicious anaemia, causing haemolysis, are even scarcer, and this paper was intended to draw physicians’ attention to this rare form of presentation.

Highlights

Once encountered with anaemic patient, clinical findings, erythrocytes indexes and peripheral blood smear results are preferred initial parameters, in algorithmic approach towards diagnosing of the cause of anaemia
Similar was the scenario with the under stated patient, where, though there was a deficiency of vitamin B12, erythrocyte indexes were compatible with microcytic to normocytic anaemia with normal red cell distribution width (RDW) in the background, and an exaggerated rise in LDH, reticulocyte counts & indirect bilirubin was seen, as if haemolytic anaemia
Anaemia is usually classified in blood loss, impaired production & increased distruction[1], and their diagnosis is usually guided initially by clinical findings and tests like erythrocytes indexes & peripheral blood smears

Summary

INTRODUCTION

Once encountered with anaemic patient, clinical findings, erythrocytes indexes and peripheral blood smear results are preferred initial parameters, in algorithmic approach towards diagnosing of the cause of anaemia. The patient reports that during the course of the last 3 months he had been having an increasingly difficult time performing daily workplace outdoor responsibilities, due to progressive generalized weakness & light-headedness which improved with ample rest. The patient visited his primary care physician for progressive symptoms and was found to be severely anaemic. Subsequent visit at 3 months showed resolution of all symptoms with improvement of CBC to Hb 11.1 gm% and normal serum B12 level

DISCUSSION

Findings

10. Antony AC