Sasi Sreethish, Yassin Mohamed A
Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Department of Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
Case Rep Oncol. 2020 Jul 2;13(2):783-788. doi: 10.1159/000507981. eCollection 2020 May-Aug.
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.
新发全血细胞减少最常见的病因是先天性骨髓衰竭综合征、骨髓占位性病变、感染和外周破坏。包括叶酸和维生素B12在内的营养缺乏偶尔可导致全血细胞减少。我们报告一名48岁男性，有1周的头晕和上消化道出血病史。实验室检查显示全血细胞减少、大细胞性贫血、毒性中性粒细胞、溶血、网织红细胞计数降低、直接抗球蛋白试验（DAT）阳性、维生素B12水平严重降低以及抗内因子和抗壁细胞抗体阳性。他开始每周接受一次维生素B12肌肉注射补充治疗，随访期间血细胞计数有所改善。认识到维生素B12缺乏是全血细胞减少和DAT阳性自身免疫性溶血性贫血的病因，有助于避免不必要的检查，并有助于早期诊断和治疗。
