[Severe microcytic anemia with megaloblastic changes in the bone marrow. A hematological paradoxon?].
We discuss the case of a 32 year-old male with severe microcytic anemia (hemoglobin 2,9 g/dl) and megaloblastic changes in the bone marrow. The patient reported of substantial dietary weight loss. The family history was positive for beta-thalassemia. Previous blood work showed iron deficiency with mild anemia. Further work-up verified beta-thalassemia minor and revealed severely decreased vitamin B12 levels with positive anti intrinsic-factor antibodies, pathognomonic for autoimmune pernicious anemia. The paradoxon therefore dissolved as a pernicious anemia with megaloblastic changes with microcytic erythrocytes due to beta-thalassemia.
Reibke
R
R
Medizinische Klinik III, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, München, Deutschland. Roland.Reibke@med.uni-muenchen.de
Hausmann
A
A
Cnossen
J
J
Hiddemann
W
W
Spiekermann
K
K
Braess
J
J
D000328:Adult; D000752:Anemia, Pernicious / Q000175:diagnosis* / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis* / Q000209:etiology*; D017086:beta-Thalassemia / Q000150:complications* / Q000175:diagnosis*