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Journal of Case Reports
Anaemia - A Conundrum

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Sourabh Sharma, Naveen Kumar, Harish Kumar Gupta, Adesh Kumar Gadpayle
From the Department of Medicine, PGIMER and Dr RML hospital, New Delhi, India.
Corresponding Author:
Dr. Sourabh Sharma
Email: drsourabh05@gmail.com
Received: 03-DEC-2013 Accepted: 18-MAR-2014 Published Online: 05-APR-2014
DOI: http://dx.doi.org/10.17659/01.2014.0028
Physicians in India commonly encounter anaemic vegan patients with peripheral smear report suggestive of macrocytosis. Many of them blindly start treating the patient for megaloblastic anaemia. Reticulocyte count of the patient is often not ordered during initial evaluation. Here, we report a case where patient was diagnosed as megaloblastic anaemia as he had macrocytosis, pancytopenia and features of hemolysis. However, patient got mesenteric vein thrombosis during hospital stay, and was eventually diagnosed to be having PNH clone. Case is presented to reiterate basic fact that reticulocyte count is often missed in initial workup of patients with anaemia and to emphasise on classic triad of PNH i.e. pancytopenia, hemolysis and venous thrombosis.
Keywords : Megaloblastic anaemia, Hemolysis, Vitamin B12 Deficiency, Folic Acid Deficiency, Pancytopenia, Reticulocytosis.
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