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Case Reports
. 2016 Sep 7;6(4):32493.
doi: 10.3402/jchimp.v6.32493. eCollection 2016.

A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia

Venkateswara K Kollipara  1 , Patrick L Brine  2 , David Gemmel  2 , Sisham Ingnam  2
Affiliations
Case Reports

A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia

Venkateswara K Kollipara et al. J Community Hosp Intern Med Perspect. .

Abstract

Pernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid. It is important for a general internist to identify pernicious anemia as one of the cause of pancytopenia and hemolytic anemia to avoid extensive workup. Pernicious anemia can present strictly with hematological abnormalities without neurological problems or vice versa as in our case.

Keywords: anti-intrinsic factor antibody; hemolytic anemia; intramedullary hemolysis; pancytopenia; pernicious anemia.

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Figures

Fig. 1
Fig. 1
Peripheral smear normocytic, normochromic anemia with ovalocytes and an admixture of “teardrop-shaped” red blood cells.
Fig. 2
Fig. 2
Bone marrow biopsy revealing hyper cellular (for age) bone marrow with significant erythroid hyperplasia and megaloblastic changes.
See this image and copyright information in PMC

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