Patient's Query
Hello doctor,
I am a general practitioner. I would like to consult with you regarding my friend, who has a normochromic normocytic anemia. His hemoglobin is currently 7.5. His diagnosis is not clear. I have all his laboratory data and bone marrow biopsy, as well as aspiration, if you want. He used to take corticosteroids with a moderate response, but he developed diabetes, which required Insulin to be controlled. I have attached his current medication list for your reference. I would be grateful if you could help me. Thank you for your attention in advance.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Based on the available information, it is evident that the patient is experiencing periodic hemolysis alongside severe vitamin B12 deficiency. The corrected RPI indicates an appropriate bone marrow response to the anemia. The potential causes for the condition include medication-induced factors, hypothyroidism, vitamin B12 and folate deficiency, lead poisoning, alcoholism, sickle cell disease, or liver disease, given the presence of transaminitis and elevated bilirubin. Hemolysis is indicated by elevated LDH, reticulocyte count, and low haptoglobin levels. The splenomegaly observed further supports the possibility of chronic liver disease or hemolysis. Notably, the low WBC count suggests peripheral destruction or nutritional deficiency rather than a bone marrow process.
The patient's vitamin B12 levels are significantly low, and G6PD levels are normal. However, additional testing or workup for hemolytic anemia, including a TSH test, should be considered. It is essential to question the use of medications such as Prednisolone, Azathioprine, Rituximab, and Mycophenolate without a concrete diagnosis, especially since they can be toxic to bone marrow. Furthermore, the patient's lack of supplementation with Vitamin B12 and Vitamin D needs clarification.
I hope this information helps you.
Feel free to ask further queries.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
Can PCOS cause an irregular menstrual cycle or heavy bleeding during periods?
What does a low WBC count suggest?
What can cause low WBC count?
ABO Hemolytic Disease of the Newborn - An Overview
How can someone with spinal pain raise his hemoglobin level?
I am O+ve and fiance is B-ve. What problems are we going to face?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.