A 63-year-old white female presents to the ER confused. The
patient’s history is positive for alcoholism. A pathology resident diagnoses
megaloblastic anemia given the history information and the peripheral blood
evaluation below. About which vitamin deficiencies should the medical student
caring for the patient be concerned?
Answer: Megaloblastic anemia results from deficiency in dietary Vitamin B12 and folate intake, as well as some drugs. Alcohol has pathologic effects on erythropoiesis, including macrocytosis, sideroblastic anemia, hemolytic anemia, and megaloblastic anemia that results from nutritional deficiency and/or direct toxic effect on erythroid precursor. Alcohol may also disturb hepatic folate metabolism.
ReplyDeleteSource: Functional vitamin B12 deficiency in alcoholics: An intriguing finding in a retrospective study of megaloblastic anemia. Alberto Fragasso, Clara Mannarella, Angela Ciacio, Andrea Sacco. European Journal of Internal Medicine, Volume 21, Issue 2, April 2010, Pages 97-100. DOI: 10.1016/j.ejim.2009.11.012