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[Megaloblastic anemia associated with diffuse intestinal Crohn's disease]
[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|January 1, 1989
Summary
Crohn's disease can cause vitamin B12 malabsorption, leading to megaloblastic anemia. Prompt treatment with vitamin B12 injections effectively resolved the anemia in this patient.
Area of Science:
- Gastroenterology
- Hematology
- Internal Medicine
Background:
- Crohn's disease, an inflammatory bowel disease, can affect nutrient absorption.
- Surgical resection of the terminal ileum, common in Crohn's disease management, impairs vitamin B12 absorption.
Observation:
- A 40-year-old male with a history of Crohn's disease and ileal resection presented with fatigue, paresthesia, and tremor.
- Blood tests revealed macrocytic anemia (MCV 131.4 fl) with megaloblastic changes in bone marrow.
- Low serum vitamin B12 and positive Schilling test indicated malabsorption, despite normal folate levels.
Findings:
- Diffuse cobblestone appearance in the small intestine confirmed extensive Crohn's disease.
- Vitamin B12 malabsorption secondary to Crohn's disease was identified as the cause of megaloblastic anemia.
- Intramuscular vitamin B12 therapy (1,000 micrograms/day) successfully corrected the anemia.
Implications:
- Highlights the importance of monitoring vitamin B12 levels in Crohn's disease patients, especially post-ileal resection.
- Demonstrates the efficacy of vitamin B12 supplementation in reversing anemia caused by malabsorption.
- Underscores the gastrointestinal and hematological manifestations of Crohn's disease.