An Exceptional Case of Cobalamin Deficiency that Presented with Extremely High Indirect Bilirubin Levels

Hamza Kaya, T. Duman, G. Kahveci, Elif Basaran, G. Aktas
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Abstract

Cobalamin deficiency anemia is a type of anemia that present with weakness, fatigue, icteric sclera and neuropathy. Main causes of cobalamin deficiency are low intake or decreased absorption (gastric and intestinal causes). In present case, we report a 65-year-old male who presented to the emergency department with signs and symptoms of cobalamin deficiency including bilateral peripheral neuropathy, icteric skin and sclera, and abdominal pain in right upper quadrant. He had low cobalamin and extremely high bilirubin levels (8mg/dL) in serum. After the diagnosis of cobalamin deficiency established, 1mg daily cobalamin treatment initiated for five days which would follow weekly and monthly intramuscular injections consequently. Hemolysis and other causes of elevated indirect bilirubin levels were excluded in differential diagnosis. Clinical and laboratory improvements were achieved after the treatment. In conclusion, physicians should kept in mind cobalamin deficiency even in subjects with unusual high levels of indirect bilirubin.
钴胺素缺乏症的一个特例,表现为间接胆红素水平极高
钴胺缺乏性贫血是一种贫血,表现为虚弱,疲劳,黄疸巩膜和神经病变。钴胺素缺乏的主要原因是摄入量低或吸收减少(胃和肠道原因)。在本病例中,我们报告了一名65岁的男性,他以双侧周围神经病变、皮肤和巩膜黄疸以及右上腹腹痛等钴胺素缺乏症的体征和症状就诊于急诊室。血清中钴胺素含量低,胆红素含量极高(8mg/dL)。在诊断出钴胺素缺乏后,开始每天1mg钴胺素治疗,持续5天,随后每周和每月进行肌肉注射。在鉴别诊断中排除了溶血和其他间接胆红素水平升高的原因。治疗后临床及实验室均有改善。总之,即使是间接胆红素水平异常高的患者,医生也应注意钴胺素缺乏症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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