Bhattacharjee Atasi, Easo Samuel Arpith
Department of Emergency Medicine, Baby Memorial Hospital, Kerala, India.
Adv J Emerg Med. 2018 Nov 17;3(2):e19. doi: 10.22114/AJEM.v0i0.103. eCollection 2019 Spring.
Pancytopenia can be caused by underlying disorders such as certain autoimmune conditions, leukemia or even a few nutritional deficiencies such as vitamin B12 deficiency. Vitamin B12 deficiency most commonly presents as megaloblastic anemia but can also be associated with pancytopenia. It can present with a range of symptoms associated with anemia and gastrointestinal or neurological systems. Understanding the etiology of the deficiency is crucial for initiating proper treatments.
A 19-year-old patient presented with complaints of dyspnea and fever, myalgia and generalized tiredness. Examinations found him to suffer pancytopenia and esophageal candidiasis caused by vitamin B12 deficiency. This deficiency can be associated to inadequate intake and the diet of the patient as a vegetarian. Parenteral B12 treatment led the patient to symptomatically improve.
Vitamin B12 deficiency is a reversible cause of bone marrow failure and can be easily treated if diagnosed early enough. Eggs and animal-derived foods constitute the usual source of this vitamin. Vitamin B12 deficiency should therefore be of high index suspicion to a clinician if the patient presents in similar conditions with a vegetarian diet. In the event of the deficiency being caused by inadequate intake or intrinsic factor deficiency, the treatment can be started quickly leading to the dramatic improvement of the patient's condition.
全血细胞减少症可能由某些自身免疫性疾病、白血病等潜在疾病引起,甚至还可能由一些营养缺乏症导致,如维生素B12缺乏。维生素B12缺乏最常见的表现为巨幼细胞贫血,但也可能与全血细胞减少症有关。它可能伴有一系列与贫血以及胃肠道或神经系统相关的症状。了解该缺乏症的病因对于开展恰当治疗至关重要。
一名19岁患者出现呼吸困难、发热、肌痛和全身乏力等症状。检查发现他患有因维生素B12缺乏引起的全血细胞减少症和食管念珠菌病。这种缺乏症可能与患者作为素食者摄入不足及饮食有关。肠外补充维生素B12治疗使患者症状得到改善。
维生素B12缺乏是骨髓衰竭的一个可逆病因,如果诊断足够早,很容易治疗。鸡蛋和动物性食物是这种维生素的常见来源。因此,如果患者以素食为主且出现类似情况,临床医生应高度怀疑维生素B12缺乏。如果缺乏是由摄入不足或内因子缺乏引起,治疗可迅速开始,从而使患者病情显著改善。