Case Report
A Puzzle of Hemolytic Anemia, Iron and Vitamin B12 Deficiencies in a 52-Year-Old Male
Table 1
Laboratory results on admission and during followup.
| | Lab | Reference | Admission | 4 weeks |
| | WBC (/mm3) | 4.2–11.0 k/mm cu | 4.7 | 5.9 | | Hb (g/dL) | 13.5–17.0 g/dL | 5.9 | 10.1 | | Hct (%) | 41.0–52.0% | 18.6 | 32.3 | | Plt (/mm3) | 140–400 k/mm cu | 161 | 241 | | MCV (fL) | 80.0–100.0 fL | 87.1 | 85.8 | | MCH (pg/red cell) | 26.0–33.0 pg | 27.4 | 26.9 | | MCHC (g/dL) | 32.0–37.0% | 31.4 | 31.4 | | RDW (%) | 11.0–14.5% | 30.7 | 21.6 | | Differential count (%) | | | | | Neutrophil | 40.0–72.0% | 59.3 | 53.2 | | Eosinophil | 0.0–10.0% | 1.1 | 1.4 | | Monocyte | 4.0–12.0% | 4.2 | 7.8 | | Lymphocyte | 17.0–45.0% | 35.1 | 36.6 | | Reticulocytes (%) | 0.5–2.8% | 2.4 | 1.2 | | Reticulocyte index | 1.0–2.0% | 0.4 | 0.6 | | PT (sec)/INR | 8.9–11.9 sec/0.9–1.1 | 15.2/1.4 | 11.9/1.1 | | PTT (sec) | 23–33 sec | 27 | NA | | Total/direct bilirubin | 0.0–1.0 mg/dL/0.0–0.3 mg/dL | 3.7/0.4 | 1.4/NA | | LDH (U/L) | 135–225 IU/L | 701 | 189 | | Haptoglobin (mg/dL) | 36–195 mg/dL | <6 | 98 | | Vitamin B12 (pg/mL) | 211–946 pg/mL | <30 | >2000 | | RBC folate (ng/mL) | >280 NG/ML RBC | 697 | 591 | | Homocysteine (Umol/L) | 3.7–13.9 Umol/L | 100 | NA | | Methylmalonic acid (nmol/L) | 87–318 nmol/L | 22708 | NA | | Iron (ug/dL) | 45–160 ug/dL | 36 | 107 | | Ferritin (ng/mL) | 30–400 ng/mL | 7 | 19 | | Iron saturation (%) | 20–55% | 9 | 23 | | TIBC (ug/dL) | 228.0–428.0 ug/dL | 403 | 456 | | IgA | 50–400 mg/dL | 612 | NA | | TTG IgA | <20.0 Units | 10.8 | NA | | Endomysial Ab | Negative | Negative | NA | | Intrinsic factor Ab | Negative | Negative | NA |
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