Case report I

Patient with a macrocytic anemia


Mrs. H.K. (38 years) came to her primary care doctor with following complaints:

History of presenting complaint:

About half a year she feels fatigue and bilateral tingling/numbness in her extremities. Symptoms worsen in time. Upon further questioning she reports frequent episodes of diarrhea and weight loss. On physical examination, doctor described tachycardia, pale skin color, subicteric sclera, beefy red tongue and a neurological examination revealed impaired sensitivity in extremities and decreased vibration senses.

Laboratory examination revealed macrocytic megaloblastic anemia, other findings were normal.

Past medical history:

Common children’s diseases. No surgery until now. 13 years vegan (vegetarian since puberty).

Abuse: Non-smoker, abstainer

Family history: Father and mother healthy, 1 son – healthy

Gynaecological history: menarche in 13 years, 1 spontaneous birth, miscarriages 0

Pharmacological history: 0

Social history: Architect

Allergy history: 0



What laboratory values ​​could lead the doctor to the diagnosis of macrocytic megaloblastic anemia ?

What basic types of anemia do you know and what are their typical laboratory findings ?

What is an anemic syndrome? Do our patient suffer from it?

Mrs. H.K. was sent to the hematology clinic, where blood was collected for further examinations.


Plasma levels of two vitamins were assessed during this examination. What vitamins were measured, and what results do you expect ? Explain.

Describe the role of these vitamins in the metabolism of erythrocytes.

It was also found that our patient has a slightly increased level of bilirubin. Could you describe the most likely cause of this finding ?

Why were several organ systems affected ?

How would you treat this condition ?