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Acta Médica Costarricense

On-line version ISSN 0001-6002Print version ISSN 0001-6012


BOLANOS-BARRANTES, Katherine; MORA-FIGULS, Daniela  and  LEON-BRATTI, María-Paz. Vitamin B12 deficiency: an atypical presentation. Acta méd. costarric [online]. 2019, vol.61, n.4, pp.183-186. ISSN 0001-6002.

Vitamin B12 deficiency it’s a reversible cause of bone marrow failure and is associated with demyelination of the nervous system, it’s important to make the diagnosis correctly and early to prevent irreversible damage. It can present with laboratory findings suggestive of hemolysis with decreased reticulocyte count unlike other forms of hemolytic anemia. The combined subacute marrow degeneration is an atypical manifestation of cobalamin deficiency, it’s a demyelinating process associated with neuronal death that occurs with very low levels of this vitamin, the initial manifestations are neurological symptoms like paresthesia in limbs and generalized weakness. This case report analyzes a 35-year-old female with a recent diagnosis of Evans syndrome, due to the presence of hemolysis. Now she comes with a medical record of 2-month presenting with paresthesias and gait instability. The physical examination documented ataxic gait, positive Romberg sing and laboratory findings that reveal macrocytic anemia and hemolysis data with decreased reticulocytes count.

Keywords : deficiency; vitamin B12; cobalamin; medular subacute combined degeneration; anemia; pancytopenia; neuropathy..

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