Vitamin B12 Deficiency an Unusual Cause of Fever: A Case Report

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Shyama . ◽  
P. Kumar ◽  
Surabhi .
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Unusual Case ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Microcytic Anemia ◽  
Peripheral Smear ◽  
Erythroid Hyperplasia ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Introduction: An unusual case of a 19 year old female, presenting with fever, pallor and hepatosplenomegaly for one month. She had microcytic anemia on peripheral smear examination but her bone marrow aspiration & biopsy revealed a hypercelluar marrow with megaloblastic erythroid hyperplasia. Resolution of fever within 48 hours of Vitamin B12 supplementation, initiated in view of the megaloblastic bone marrow picture & low serumVitamin B12 level, suggests a causal association. Conclusion: Vitamin B12 deficiency seems to be an unusual cause of PUO (Pyrexia of unkown origin) which should be ruled out in every case of PUO.

scholarly journals What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B12 deficiency?

2013 ◽  
Vol 2013 (jul08 1) ◽  
pp. bcr2013010200-bcr2013010200 ◽  
Author(s):  
J. Randhawa ◽  
S. L. Ondrejka ◽  
S. Setrakian ◽  
H. Taylor
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Aspiration Biopsy ◽  
B12 Deficiency

scholarly journals A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

2020 ◽  
Vol 7 (4) ◽  
pp. 566
Author(s):  
Janak G. Chokshi ◽  
Bhargavkumar I. Patel ◽  
Ishvarlal M. Parmar ◽  
Dipen R. Damor
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Examination ◽  
Radiological Imaging ◽  
Peripheral Smear ◽  
Drug Induced ◽  
Presenting Symptoms ◽  
Function Test ◽  
B12 Deficiency

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

scholarly journals A study on incidence of vitamin B12 deficiency in patients with pancytopenia

2019 ◽  
Vol 6 (5) ◽  
pp. 1402
Author(s):  
G. Sathish Kumar ◽  
Swetha . ◽  
V. Rajendran
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Hematological Parameters ◽  
Vitamin B12 Deficiency ◽  
Disease Process ◽  
Bone Marrow Aspiration ◽  
Megaloblastic Anaemia ◽  
Clear Understanding ◽  
Female Ratio ◽  
B12 Deficiency

Background: Pancytopenia is a serious and life threatening illness presented with multiple etiologies. The current study was done with the objective to evaluate the clinic-pathological factors responsible for incidence of pancytopenia in patients with vitamin B12 deficiency and their response to the therapy with vitamin B12.Methods: It was an observational study carried out at Department of Medicine, Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu during the period between December 2016 to December 2017. A total 50 patients with pancytopenia were clinically evaluated along with hematological parameters and bone marrow aspiration.Results: A total of 50 patients were included in the study. The mean age of the patients was 32.84 years with a male to female ratio of 1.5:1. All patients had history of fatigability. Commonest physical presentation was pallor (100%). Megaloblastic anaemia was the predominant blood picture in 58% patients. The common bone marrow finding was hyper cellular marrow with megaloblastic picture. Management with cyanocobalamin preparations and folate supplementations, significantly improved the reticulocyte count percentage in patients with pancytopenia (p=0.01)Conclusion: The study concluded that the most common cause of pancytopenia was megaloblastic anaemia. Detailed haematological investigations along with bone marrow aspiration in patients with cytopenia provided a clear understanding of disease process to identify the etiologies of pancytopenia.

scholarly journals Vitamin B12 Deficiency Resembling Acute Leukemia: A Case Report

2021 ◽  
Vol 59 (243) ◽  
pp. 1182-1184
Author(s):  
Nisha Sharma ◽  
Saru Kunwar ◽  
Anil Kumar Shrestha
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Vitamin B12 ◽  
Megaloblastic Anemia ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Peripheral Blood Smear ◽  
Poor Growth ◽  
B12 Deficiency ◽  
Chronic Fever

Vitamin B12 deficiency in children can cause megaloblastic anemia, poor growth, and increased chances of infections. It is an important reversible cause of bone marrow suppression which at the time of presentation can mimic hematological malignancy. Therefore, it should be considered as a differential diagnosis in cases suspected of acute leukemia. We report a case of 14 months old child who had atypical presentation of vitamin B12 deficiency. He had chronic fever, decreased feeding and increased paleness for one year. Pancytopenia with severe anemia was present along with 19% reactive/atypical cells in peripheral blood smear suggesting acute leukemia. However, bone marrow aspiration and biopsy showed features of megaloblastic anemia. Vitamin B12 level measured was very low and treatment with cyanocobalamin caused drastic improvement in the child’s condition.

scholarly journals Microcytic Anemia Hiding Vitamin B12 Deficiency Anemia

Cureus ◽  
2021 ◽  
Author(s):  
Fadi Busaleh ◽  
Omkolthoom A Alasmakh ◽  
Fatimah Almohammedsaleh ◽  
Maram F Almutairi ◽  
Juwdaa S Al Najjar ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
B12 Deficiency

scholarly journals Hematologic Manifestations of Vitamin B12 Deficiency in Swine

Blood ◽  
1951 ◽  
Vol 6 (10) ◽  
pp. 867-891 ◽  
Author(s):  
G. E. CARTWRIGHT ◽  
BETTY TATTING ◽  
JEAN ROBINSON ◽  
N. M. FELLOWS ◽  
F. D. GUNN ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Liver Damage ◽  
Megaloblastic Anemia ◽  
Macrocytic Anemia ◽  
Vitamin B12 Deficiency ◽  
Deficiency Anemia ◽  
Severe Neutropenia ◽  
Pteroylglutamic Acid ◽  
B12 Deficiency

Abstract In an effort to produce a deficiency of vitamin B12 a total of 70 pigs were fed a purified diet containing soybean alpha protein in place of casein. One group of animals was started on the diet at 2 to 7 days of age. A second group began at 21 to 28 days of age. Methionine, iodinate casein, desiccated thyroid and pteroylglutamic acid were added to the diet of certain animals and! omitted from the diet of other pigs. In addition, 9 pigs were gastrectomized. Forty-three of the animals survived for a sufficiently long period of time for adequate evaluation of the results of the experiment. Severe liver damage was observed in 24 of the 25 animals autopsied. The only animal not showing liver damage received vitamin B12 from the beginning of the experiment. Necrosis of the liver cells, fatty infiltration, or both, occurred in the presence of a high fat diet containing apparently adequate amounts of protein, choline, vitamin E and methionine. These pathologic changes were apparently prevented but not reversed by the administration of vitamin B12. Growth of the animals on the above diets without added vitamin B12 was retarded as compared with the growth of animals on the same diet supplemented with this vitamin. The administration of vitamin B12 to the deficient animals resulted in rapid growth. Of the 39 animals not receiving vitamin B12 13 failed to develop anemia, 16 developed a mild anemia and in 10 a moderately severe anemia was present. When present the anemia was normocytic and in 24 pigs was accompanied by a moderately severe neutropenia. Differential cell counts on the sternal marrow were normal except for a slight increase in the proportion of normoblasts. These hematologic alterations were neither consistently or completely corrected by the administration of vitamin B12 in spite of the fact that definite and sometimes marked reticulocyte increases followed. When methionine deficiency was associated with vitamin B12 deficiency, anemia appeared to be more severe. The administration of aureomycin, an "animal protein factor," did not stimulate growth and failed to induce a hemopoietic response. There was no macrocytic anemia, the bone marrow was not megaloblastic, and neurologic disturbances or morphologic alterations in the neutrophils were not observed. These results are in contrast to those obtained in pigs with an experimentally produced deficiency of pteroylglutamic acid. Such animals develop macrocytic anemia, leukopenia and a macronormoblastic type of bone marrow. It is not possible to give with any assurance the reason why megaloblastic anemia was not produced in the "B12-deficient" animals. This may have been due to the fact that (1) the deficiency was not sufficiently severe to result in such a change in the hemopoietic system; or (2) because pteroylglutamic acid prevents the development of megaloblastic anemia even in the absence of vitamin B12.

scholarly journals Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

2018 ◽  
Vol 7 (2) ◽  
pp. 309 ◽  
Author(s):  
Shailendra D. ◽  
Rizwan Kalani ◽  
K. M. Venkat Narayan ◽  
Dorairaj Prabhakaran ◽  
Nikhil Tandon ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Rural Community ◽  
Odds Ratio ◽  
Complete Blood Count ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Oral Vitamin ◽  
South Indian ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

scholarly journals Unusual presentation of vitamin B12 deficiency in a 3 month old infant: presentation with hemolysis and thrombocytopenia

2020 ◽  
Vol 7 (8) ◽  
pp. 1816
Author(s):  
Poornima Shankar ◽  
Anil H.
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Well Being ◽  
The Body ◽  
Elevated Bilirubin ◽  
B12 Deficiency ◽  
Laboratory Investigations ◽  
Vitamin B12 Supplementation ◽  
Poor Weight Gain

A 3 month old infant exclusively breast fed presented with vomiting and poor weight gain with purpuric and echymotic patches all over the body. The child also had hyperpigmentation over knuckles and icterus. Laboratory investigations revealed severe dimorphic anemia with thrombocytopenia, elevated bilirubin and LDH levels and severe vitamin B12 deficiency. Following vitamin B12 supplementation there was improvement in well-being including feed tolerance, icterus resolved and in follow up lab studies there was improvement in hemoglobin and platelet counts along with reduced bilirubin levels. Through this case report we want to emphasize the possibility of vitamin B12 deficiency presenting as hemolytic anemia and psuedothrombotic microangiopathy.

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