Severe Hemolytic Anemia due to Vitamin B12 Deficiency in Six Months

Vitamin B12 deficiency is common in vegetarians, as meat is a common source of vitamin B12. In this case presentation, a patient presented to his primary care doctor with signs of severe vitamin B12 deficiency anemia. He had elevated lactate dehydrogenase levels, indirect bilirubin, and schistocytes on the blood smear, all pointing toward a hemolytic process. A severe vitamin B12 deficiency was deemed the cause of this hemolytic anemia after ruling out other causes. We highlight the importance of knowing more about this pathogenesis to avoid unnecessary workup and management for an elementary disorder that can result from severe B12 deficiency.

Section: Discussionmentioning

confidence: 89%

“…Primary TMA includes thrombotic thrombocytopenic purpura, Shiga toxin-mediated hemolytic uremic syndrome, drug-induced TMA, and complement-mediated TMA. The hallmark of diagnosis is microangiopathic hemolytic anemia, thrombocytopenia, renal and neurological abnormalities, and gastrointestinal and cardiac features [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Pseudo-Thrombotic Thrombocytopenic Purpura Due to Severe Vitamin B12 Deficiency: A Case Report

Sathi¹,

Luhadia²,

Yashi³

et al. 2023

“…This case highlights an unusual, yet potentially fatal, aspect of pernicious anemia: hemolysis. Vitamin B12 is required for the conversion of homocysteine to tetrahydrofolate, which is important for DNA production [ 11 ]. With B12 deficiencies, accumulation of homocysteine causes oxidative stress to erythrocytes leading to hemolysis as seen in vitro studies; however, the completed pathogenesis is unknown [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Pernicious Anemia Presenting With Severe Hemolysis

Romero,

Patel,

Rai

et al. 2023

Vitamin B12 deficiency is a well-known and overall common disease. While the etiology of vitamin B12 deficiency varies from post-surgical changes to inadequate dietary consumption, pernicious anemia should be considered as it is a common cause. Pernicious anemia is an autoimmune atrophic gastritis impairing the absorption of vitamin B12. Manifestations include neurological changes, macrocytic anemia, glossitis, and nail changes. Hemolytic anemia is an unusual complication of vitamin B12 deficiency and an even more unusual initial presentation. This case identifies a patient with previously undiagnosed pernicious anemia with severe vitamin B12 deficiency compounded by hemolytic anemia as the presenting symptom. Overall, this case highlights the importance of considering vitamin B12 deficiency-related hemolytic anemia and the need for further research into the causes and pathophysiology of vitamin B12-induced hemolysis due to its potential for fatal outcomes despite being easily treatable with cost-effective methods to treat.

“…The increased levels of homocysteine and subsequent accumulation produce hemolysis by oxidative damage. However, this is extremely rare in only 1.5% of severe deficiencies [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Cold Agglutinin Disease, Severe B12 Deficiency, and Pernicious Anemia: A Deadly Coincidence

Guevara¹,

Perez²,

Sanchez³

et al. 2023

Anemia is the most common hematological disorder. It is commonly a manifestation of an underlying disease. Its causes are multifactorial, including but not limited to nutritional deficiencies, chronic conditions, inflammatory processes, medications, malignancy, renal dysfunction, hereditary diseases, and bone marrow disorders. We present a case of a patient exhibiting anemia related to cold agglutin disease and severe B12 deficiency secondary to pernicious anemia.