Spurious laboratory alterations in pernicious anemia

Roque, Adriana Isabel Dias; Silva, Cláudia Nadine da; Martins, Joana Maria dos Reis Mata Albuquerque; Pereira, Amélia

doi:10.1016/j.bjhh.2015.07.008

Cited by 1 publication

(1 citation statement)

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“…We present a case of APS II presenting initially with jaundice owing to development of pernicious anaemia even before onset of overt adrenal insufficiency. Unconjugated hyperbilirubinaemia can occur in severe pernicious anaemia due to ineffective erythropoiesis 6. In many case series from the Indian subcontinent, megaloblastic anaemia has been among the most frequent causes of pancytopaenia 7.…”

Section: Discussionmentioning

confidence: 99%

Jaundice and anaemia as presenting features of an incomplete autoimmune polyglandular syndrome type II

Banerjee¹,

Mondal

Maisnam

et al. 2019

BMJ Case Rep

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The coexistence of adrenal failure with either autoimmune thyroid disease and/or type 1 diabetes is defined as autoimmune polyglandular syndrome (APS) type 2 or Schmidt’s syndrome. Vitiligo, hypergonadotropic hypogonadism, chronic autoimmune hepatitis, alopecia, pernicious anaemia and seronegative arthritis may also be present. We present a case of 45-year-old Indian man with progressive jaundice and asthenia for 3 months. He was also found to have pallor, icterus, dry coarse skin and delayed relaxation of ankle jerk. Investigations showed pancytopaenia with megaloblastic changes due to pernicious anaemia, autoimmune hypothyroidism and autoimmune adrenalitis with evolving adrenal insufficiency. Upper gastrointestinal endoscopy guided biopsy showed evidence of gastric mucosal atrophy. Patient responded well to hydroxocobalamin and thyroxine replacement. Detailed workup to check for evolving APS II is prudent in a hypothyroid patient presenting with pallor and jaundice. It may alert physicians to possible adrenal crisis in the future, especially after starting levothyroxine replacement in these patients.

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Section: Discussionmentioning

confidence: 99%