HomeAnswersInternal Medicinevitamin b12 deficiencyCan you please confirm my friend's diagnosis?

We are not sure about my friend's diagnosis. Kindly help.

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Published At September 20, 2016
Reviewed AtJuly 28, 2023

Patient's Query

Hi 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 corticosteroid with moderate response, but he developed diabetes and that 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.

Answered by Dr. Sadaf Mustafa

Hello,

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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sadaf Mustafa
Dr. Sadaf Mustafa

Internal Medicine

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