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Case Reports
. 2012 Aug;137(34-35):1693-6.
doi: 10.1055/s-0032-1305226. Epub 2012 Aug 14.

[Pronounced Pancytopenia With Concomitant Jaundice in a 66-year-old Woman]

[Article in German]
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Case Reports

[Pronounced Pancytopenia With Concomitant Jaundice in a 66-year-old Woman]

[Article in German]
V Kächele et al. Dtsch Med Wochenschr. .

Abstract

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.

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