This study presents 12 patients (7 women and 5 men) with vitamin B12-responsive pancytopenia who had discordant laboratory findings and were misdiagnosed as having myelodysplastic syndrome (MDS). The median hemoglobin level was 6.5 g/dl, and the leukocyte and platelet counts were 2.85 × 109/l and 55.5 × 109/l, respectively. The median serum lactate dehydrogenase level was high (3,204.5 IU/l). The serum vitamin B12 levels were within normal limits at the initial evaluation, but a serial follow-up of the vitamin B12 levels revealed either fluctuations or a gradual decrease. The patients were initially diagnosed with MDS and responded rapidly to a 7-day parenteral B12 treatment with normal complete blood counts (CBCs). We propose that patients suspected to have MDS may suffer from vitamin B12 deficiency and that this can be revealed by a normalization of CBCs following 7 days of treatment with parental vitamin B12.

Keywords:
Myelodysplastic syndrome, Pancytopenia, Vitamin B12
1.
Oh RC, Brown DL: Vitamin B12 deficiency. Am Fam Physician 2003;67:979–986.
2.
Wickramasinghe SN: Diagnosis of megaloblastic anaemias. Blood Rev 2006;20:299–318.
3.
Andrès E, Affenberger S, Federici L, Korganow AS: Pseudo-thrombotic microangiopathy related to cobalamin deficiency. Am J Med 2006;119:e3.
4.
Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G, Maloisel F, Weitten T, Kaltenbach G, Blickle JF: Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haematol 2006;28:50–56.
5.
Gale DP, Cobbold JF, Chataway J: Steroid-responsive functional B12 deficiency in association with transcobalamin II polymorphism 776C→G. Eur J Haematol 2006;76:75–78.
6.
Rodbro P, Dige-Petersen H, Schwartz M, Dalgaard OZ: Effect of steroids on gastric mucosal structure and function in pernicious anemia. Acta Med Scand 1967;181:445–452.
7.
Andrès E, Fothergill H, Mecili M: Efficacy of oral cobalamin (vitamin B12) therapy. Expert Opin Pharmacother 2010;11:249–256.
© 2011 S. Karger AG, Basel
2011
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