Andrew Sagalov^1,, Sujitha Ketineni², Mohammad Hussain², Ruchika Goel²

An elderly woman was brought to the emergency department following a one-week history of progressively worsening epigastric pain and generalized weakness. Her symptoms began approximately two years before admission; however, she did not seek medical attention as her symptoms were mild. Vital signs were stable on presentation, while her pain persisted following administration of morphine. A computed tomography scan of her abdomen did not identify any acute pathology. Laboratory evaluation revealed megaloblastic anemia, a critically low vitamin B12 count, and evidence of hemolytic anemia (HA). She was treated with cyanocobalamin injections and her abdominal pain resolved. This case demonstrates a rare instance of acquired HA as a complication of vitamin B12 deficiency. Furthermore, our manuscript emphasizes clinicians should recognize megaloblastic anemias are not always macrocytic and to conduct a thorough medical history when evaluating an anemia.

Vitamin B12, hemolytic anemia, pernicious anemia, Homocysteine