Jayte Mohamed, Hersi Abishir Mohamud, Jama Yahya Mohamed, Karshe Abdifatah, Hassan Adan Abdi, Abdi Awil Abdulkadir
Internal Medicine Department, Kampala International University, Kampala, Uganda.
Br J Community Nurs. 2025 Apr 2;30(4):180-183. doi: 10.12968/bjcn.2024.0132.
Severe vitamin B12 deficiency can lead to pancytopenia, haemolysis and various systemic manifestations. This case report discussed the case of a 66-year-old male patient who had adhered to a strict vegetarian diet for 5 years and presented with symptoms of fatigue, pallor and leg pain. Laboratory tests revealed severe pancytopenia (haemoglobin 4.8 g/dL, white cell count 2630/µL, platelets 112 000/mm), macrocytic anaemia (mean cell volume 118 fL) and elevated lactate dehydrogenase (5480 U/L). Serum vitamin B12 was critically low at 61 pg/mL and bone marrow aspiration confirmed megaloblastic erythropoiesis. Intramuscular vitamin B12 supplementation resulted in rapid clinical and haematologic improvement, with complete resolution of pancytopenia and indirect hyperbilirubinaemia within 2 weeks. This case underscores the importance of early recognition of vitamin B12 deficiency in patients with unexplained cytopenia and haemolysis, particularly in populations with restrictive dietary habits. The authors discuss vitamin B12 deficiency in clinical practice, emphasising the need for awareness among healthcare providers to prevent irreversible complications through timely intervention and appropriate dietary counselling.
严重的维生素B12缺乏可导致全血细胞减少、溶血及各种全身表现。本病例报告讨论了一名66岁男性患者的病例，该患者坚持严格素食饮食5年，出现疲劳、面色苍白和腿痛症状。实验室检查显示严重全血细胞减少（血红蛋白4.8 g/dL，白细胞计数2630/µL，血小板112 000/mm）、大细胞性贫血（平均红细胞体积118 fL）及乳酸脱氢酶升高（5480 U/L）。血清维生素B12极低，为61 pg/mL，骨髓穿刺证实为巨幼细胞性红细胞生成。肌肉注射维生素B12补充剂后，临床和血液学迅速改善，2周内全血细胞减少和间接胆红素血症完全消退。本病例强调了早期识别不明原因血细胞减少和溶血患者中维生素B12缺乏的重要性，特别是在有严格饮食习惯的人群中。作者讨论了临床实践中的维生素B12缺乏，强调医疗保健提供者需要提高认识，通过及时干预和适当的饮食咨询来预防不可逆的并发症。
