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Pain Management 2019 & Internal Medicine 2019 International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X Page 42
JOINT EVENT
7th Edition of International Conference on
Pain Management
8th Edition of International Conference on
Internal Medicine &
Patient Care
&
March 25-26, 2019
Rome, Italy
Nikoletta Daoulari, Int J Anesth Pain Med 2019, Volume 5
DOI: 10.21767/2471-982X-C1-006
Vitamin B12 deficiency diagnosis in emergency
department presenting as severe pancytopenia
Nikoletta Daoulari
Hospital Brugmann Bruxelles, Belgium
Background: Deficiency of vitamin B12 (cobalamin)
is a well-known cause of megaloblastic anemia. It is a
reversiblecauseofbonemarrowfailureanddemyelinating
nervous system disorder, hence early detection and
prompt treatment of vitamin B12 deficiency is essential.
Documented symptomatic pancytopenia related to B12
deficiency is very rare representing less than 5% cases
making the diagnosis in emergency department more
challenging.
Clinical case: A 52-year old woman with a history of
Graves Basedow’s disease is sent by her generalist to
the emergency department to be transfused for severe
anemia found in blood test without any other information.
Her complaints of extreme tiredness and dyspnea at the
least effort aggravated this past week without signs of
melena or hematemesis. She describes having lost 13
kilos in a 3-month period and loss of appetite. No chest
pain but sometimes palpitations. She has been put on
propylthiouracil stopped two months ago. No others
medications, no drugs but consummation of alcohol 2-3
glasses per day the last 25 years. In physical examination
she is pale and icteric but the rest is normal. She has no
fever and her electrocardiography reveals sinus rhythm
without evidence of myocardial ischemia. Laboratory
testing reveals a profound pancytopenia with severe
macrocytosis, no blasts, LDH 4860 UI/L and indirect
bilirubin 1.6 mg/dL. The rest was normal and further
workup for the cause of pancytopenia revealed non-
measurable levels of B12 and folic acid. Direct Coombs
was negative. Treatment with intramuscular injection
of B12 and folic acid POS was started and control with
abdominal scanning and gastroscopy were scheduled
during hospitalization to investigate the cause of B12
deficiency. After oneweek of treatment laboratory testing
control shows retreat of pancytopenia
Conclusions: Vitamin B12 deficiency is a rare condition
and the presentation with severe pancytopenia is
challenging for the emergency physicians. Prompt
treatment in emergency department without waiting
the results of levels of B12 must be considered to avoid
deterioration of neurological condition with serious
consequences for the quality of patient’s life.
Biography
Nikoletta Daoulari is a Internal Medicine Resident at General
Hospital of RIO, University of Patras, Greece. Her research inter-
est is Internal Medicine. She also worked as Assistant in Emer-
gency Department at Hospital Brugmann Bruxelles.