Patient's Query
Hello doctor,
I am a general practitioner. I would like to consult with you regarding my friend, who has a normochromic normocytic anemia. His hemoglobin is currently 7.5. His diagnosis is not clear. I have all his laboratory data and bone marrow biopsy, as well as aspiration, if you want. He used to take corticosteroids with a moderate response, but he developed diabetes, which required Insulin to be controlled. I have attached his current medication list for your reference. I would be grateful if you could help me. Thank you for your attention in advance.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Based on the available information, it is evident that the patient is experiencing periodic hemolysis alongside severe vitamin B12 deficiency. The corrected RPI indicates an appropriate bone marrow response to the anemia. The potential causes for the condition include medication-induced factors, hypothyroidism, vitamin B12 and folate deficiency, lead poisoning, alcoholism, sickle cell disease, or liver disease, given the presence of transaminitis and elevated bilirubin. Hemolysis is indicated by elevated LDH, reticulocyte count, and low haptoglobin levels. The splenomegaly observed further supports the possibility of chronic liver disease or hemolysis. Notably, the low WBC count suggests peripheral destruction or nutritional deficiency rather than a bone marrow process.
The patient's vitamin B12 levels are significantly low, and G6PD levels are normal. However, additional testing or workup for hemolytic anemia, including a TSH test, should be considered. It is essential to question the use of medications such as Prednisolone, Azathioprine, Rituximab, and Mycophenolate without a concrete diagnosis, especially since they can be toxic to bone marrow. Furthermore, the patient's lack of supplementation with Vitamin B12 and Vitamin D needs clarification.
I hope this information helps you.
Feel free to ask further queries.
Thank you.
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Answered byDr. Sadaf Mustafa
Medically reviewed byiCliniq medical review team
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