Pernicious Anaemia with Normal Vitamin B12

• Main Authors: Joao Galaz Tavares, Bernardo Baptista, Bebiana Gonçalves, Alexandra Bayão Horta
• Format: Article
• Language: English
• Published: SMC MEDIA SRL 2019-02-01
• Series: European Journal of Case Reports in Internal Medicine
• Subjects: Anti-intrinsic factor antibodies; myelodysplastic syndrome; pernicious anaemia; vitamin B12 deficiency; spuriously normal vitamin B12
• Online Access: https://www.ejcrim.com/index.php/EJCRIM/article/view/1045

A 49-year-old female patient presented to our hospital with asthenia, odynophagia, low grade fever, worsening symptoms of chronic depression, and symmetric leg paresthesias. Investigations showed macrocytic anaemia, leucopenia, thrombocytopenia, high lactate dehydrogenase levels and a normal Coombs test. Trilineage dysplasia was detected in the bone marrow biopsy specimen. The diagnostic work-up led us to the diagnosis of pernicious anaemia with a spuriously normal value of vitamin B12 and high titres of anti-intrinsic factor autoantibodies. This case highlights the importance of considering vitamin B12 deficiency in the differential diagnosis of myelodysplasia, even when vitamin B12 levels seem to be normal.