A Rare Case of Acquired Hemolytic Anemia and Pancytopenia Secondary to Pernicious Anemia

Abstract

The commonest etiologies of new-onset pancytopenia are congenital bone marrow failure syndromes, marrow space-occupying lesions, infections, and peripheral destruction. Nutritional deficiencies, including folate and vitamin B12, can occasionally cause pancytopenia. We report a 48-year-old gentleman who presented with a 1-week history of dizziness and upper gastrointestinal bleeding. Laboratory evaluation revealed pancytopenia, macrocytosis, toxic neutrophils, hemolysis, suppressed reticulocyte count, positive direct anti-globulin test (DAT), severely reduced B12 levels, and positive anti-intrinsic factor and anti-parietal cell antibodies. He was started on weekly intramuscular B12 supplementation and showed improvement in blood cell counts during follow-up. Recognition of B12 deficiency as a cause of pancytopenia and DAT-positive autoimmune hemolytic anemia can help to avoid unwanted investigations and aid in early diagnosis and treatment.

Severe Vitamin B12 Deficiency Presenting as Pancytopenia, Hemolytic Anemia, and Paresthesia: Could Your B12 Be Any Lower?

“…Hematologic consequences include macrocytosis, hypersegmented neutrophils, leukopenia, thrombocytopenia, and rarely, pancytopenia; in fact, pancytopenia, in which all blood cell lines are decreased, is seen in only 5% of patients with a known B12 deficiency [ 9 ]. Typically, with profound anemia as exhibited in this patient, tachycardia would be an expected associated vital sign, but in this case was normal, likely due to the chronicity of his disease state.…”

Hemorrhagic manifestation in different etiologies of pancytopenia

“…[ 4 7 ] Megaloblastic anemia in addition to severe B12 deficiency in some cases causes pancytopenia and hemolysis. [ 10 ] The incidence of aplastic anemia varies from 10% to 52.7% of all pancytopenia patients in different studies from all over the world. [ 11 12 ] It was found that the incidence of bleeding manifestation in patients of aplastic anemia having platelet count less than 20,000/cu mm was statistically significant than the patient with platelet count more than 20,000/cu mm (P- value < 0.001).…”

A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults

“…Even if a delay could not impair the diagnostic assurance with neurologic symptoms, their treatment would be started promptly to avoid the risk of irreversibility including extensive sensory defects, gait disturbances, and mental changes. The presence of dizziness and generalized weakness for three days, presence of fever, scleral icterus, conjunctival pallor, and hyperpigmentation of the knuckles of both hands presented in a 48-year-old male case reported by Sasi and Yassin [ 29 ]. On admission, the patient’s values were: Hb 6.5 g/dL, MCV 102.6 fL.…”

“…Hussain et al[28].Full blood profile, Vitamin B 12 , Folate, Haptoglobin, MMA, Intrinsic factor antibody At six-month follow-up clinical and laboratory analysis improvement (e.g., hemoglobin improved to 11.9 gm/d).Sasi and Yassin[29].Full blood profile, B 12 level, Bilirubin, LDH Haptoglobin, direct antiglobulin (DAT) Serum iron, thyroid functions Blood cell counts started showing an upward trend on day 4 after starting the treatment. On discharge, after 10 days of hospital stay, improvement of blood profile and vitamin B 12 (from values <37 pmol/L to 369 pmol/L), remission of all symptoms.…”