Anemia secondary to combined deficiencies of iron and cobalamin

The focus of attention on combined-deficiency anemia is often on concurrent deficiencies of cobalamin (vitamin B12) and folate, emphasizing the correction of megaloblastic changes with folate alone and risking neurologic sequelae of uncorrected simultaneous cobalamin deficiency. Simultaneous deficiencies of cobalamin and iron, however, may be a more common cause of combined-deficiency anemia. Variability in red blood cell morphologic characteristics in this setting reflects the relative degree of deficiency of each of these substrates. A patient with combined cobalamin and iron deficiency anemia with microcytic, hypochromic indices and the absence of hypersegmented neutrophils was treated. This case and the literature reviewed emphasize the need to consider combined-deficiency states in all cases of anemia.