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


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Hämato-Onkologische Praxis Ulm. volker.kaechele@gmx.de
V
V
Kächele
W
W
Schneider-Kappus
M
M
Bommer
D000368:Aged; D000748:Anemia, Macrocytic / Q000188:drug therapy / Q000209:etiology; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D003937:Diagnosis, Differential; D004909:Erythrocyte Indices; D005260:Female; D005757:Gastritis, Atrophic / Q000175:diagnosis* / Q000188:drug therapy; D005773:Gastroscopy; D006801:Humans; D007262:Infusions, Intravenous; D007565:Jaundice / Q000188:drug therapy / Q000209:etiology*; D008534:Megaloblasts / Q000187:drug effects / Q000473:pathology; D010198:Pancytopenia / Q000188:drug therapy / Q000209:etiology*; D014463:Ultrasonography; D014805:Vitamin B 12 / Q000008:administration & dosage
D014805:Vitamin B 12