Considering the association between decreased B12 absorption and PPI use, together with macrocytic anemia
findings on his CBC and the physical exam findings of enlarged tongue and lip tingling, it is likely this patient also has a B12 deficiency.
Patients with macrocytic anemia
were evaluated for Vitamin B12 and folic acid levels.
Furthermore, in the background of macrocytic anemia
and a reticulocyte index of 1.04 at presentation, which worsened to Hb of 6.9 mg/dL and Hct of 20.6% on the third day of presentation, the initial serum Vitamin B12 returned to low level (202 pg/mL, normal 211-946 pg/mL) with normal serum folate (5.9 ng/mL, normal > 3.0 ng/mL) in the presence of anti-intrinsic factor (IF) antibody.
Additionally, he did not present any vitamin deficiencies or any blood count disturbances, particularly iron deficiency or macrocytic anemia
, which could be an etiologic factor as pointed out by Sharma et al.
The spectrum of etiologies associated with macrocytic anemia
includes nutritional deficiencies (e.g.
Interestingly the patient presented had mild macrocytic anemia
(hemoglobin 10.7 g/dL and mean corpuscular volume 103 [my][m.sup.3]).
Surgestone and Provames, are used in a range of women's health indications, Speciafoldine is used to treat macrocytic anemia
, while Tredemine is a World Health Organization recognized essential medicine to treat tapeworm.
Supporting the role of autoantibodies in its pathogenesis, Good's syndrome also has many autoimmune manifestations, such as pure red cell aplasia (34.8%), aplastic anemia (7.9), macrocytic anemia
(5.6%), and autoimmune hemolytic anemia (3.4) .
Although the patient had no evidence of macrocytic anemia
in complete blood count, we measured the level of vitamin [B.sub.12] because the patient had hypotonicity and found it to be low.
N's vitamin [B.sub.12] deficiency could have been affecting his mental status; consequently, we ordered routine laboratory work-up that included a complete blood count with differential and peripheral smear, which showed macrocytic anemia
Zidovudine is associated with macrocytic anemia
. True autoimmune hemolytic anemia is rare.
As no child had Macrocytic anemia
so Serum levels of folate and vitamin B12 were not performed.
Folic acid deficiency impairs DNA synthesis and causes megaloblastic anemia.7 WHO describes folic acid deficiency as a basic health problem in many countries.8 In Pakistan 45% of the population with macrocytic anemia
has folate deficiency.9 Adequate supply of this vitamin during infancy is essential for normal growth and development.10 Breast fed infants are most likely to receive sufficient amount of folate.
The suspicion of sepsis was ruled out by the infectious disease department and a severe hyporegenerative macrocytic anemia
In the present study, the superior RBCs findings was normocytic normochromic anemia (48%) followed by macrocytic anemia