[Pronounced pancytopenia with concomitant jaundice in a 66-year-old woman]

Dtsch Med Wochenschr. 2012 Aug;137(34-35):1693-6. doi: 10.1055/s-0032-1305226. Epub 2012 Aug 14.
[Article in German]


History and admission findings: A previously healthy 66-year-old women presented with onset of general weakness, shortness of breath and significant weight loss. Due to appearance of jaundice, biliary obstruction had been ruled out by a CAT scan previous to the patients presentation in our practice.

Investigations: The laboratory tests already arranged by the patients general practitioner showed a pronounced pancytopenia with megaloblastic anemia and hyperbilirubinemia. The bone marrow aspiration revealed a hypercellular bone marrow with megaloblastic erythropoiesis. The diagnosis of pernicious anemia was confirmed by the low cobalamin (vitamin B12) serum level and the presence of atrophic gastritis.

Treatment: Pernicious anemia was treated with intramuscular injection of Cyanocobalamin (1000 µg) which resulted in an immediate reticulocytosis and a widely normalized blood cell count and bilirubin level four weeks after initiation of treatment.

Conclusion: The differential diagnosis of megaloblastic anemia covers a wide spectrum of diseases with different etiology. This case report demonstrates an example of a pernicious anemia with atypical and foudroyant clinical course.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aged
  • Anemia, Macrocytic / drug therapy
  • Anemia, Macrocytic / etiology
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / drug therapy
  • Biopsy
  • Bone Marrow / pathology
  • Diagnosis, Differential
  • Erythrocyte Indices
  • Female
  • Gastritis, Atrophic / diagnosis*
  • Gastritis, Atrophic / drug therapy
  • Gastroscopy
  • Humans
  • Infusions, Intravenous
  • Jaundice / drug therapy
  • Jaundice / etiology*
  • Megaloblasts / drug effects
  • Megaloblasts / pathology
  • Pancytopenia / drug therapy
  • Pancytopenia / etiology*
  • Ultrasonography
  • Vitamin B 12 / administration & dosage


  • Vitamin B 12