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Desvelar la verdad perniciosa: un informe de caso sobre la rara presentación de una deficiencia severa de vitamina
Olawale O Akinola1, Anvitha Mandapati2, Nathan Douthit1
1Internal Medicine, East Alabama Medical Center, Opelika, USA.
Cureus
|February 20, 2026
Resumen
La anemia perniciosa, una condición autoinmune, puede imitar la anemia hemolítica, lo que lleva a un diagnóstico erróneo. El reemplazo temprano de la vitamina B12 es crucial para la recuperación hematológica y la prevención del daño neurológico.
Área de la Ciencia:
- Hematología Hematología.
- Endocrinología Endocrinología.
- La autoinmunología es autoinmunología.
Sus antecedentes:
- La deficiencia de vitamina B12 comúnmente causa anemia megaloblástica.
- En raras ocasiones, se presenta con características hemolíticas, imitando afecciones autoinmunes o microangiopáticas.
- La anemia perniciosa, una causa autoinmune de la deficiencia de B12, a menudo no se reconoce y se asocia con otros trastornos autoinmunes.
Objetivo del estudio:
- Para reportar un caso de anemia perniciosa que se presenta como anemia hemolítica.
- Para resaltar los desafíos de diagnóstico y hacer hincapié en el reconocimiento y tratamiento temprano.
Principales métodos:
- Informe de caso de una mujer de 45 años con tiroiditis de Hashimoto.
- Evaluación de laboratorio que incluye hemograma completo, frotis periférico, LDH, haptoglobina, prueba de Coombs, G6PD y niveles de vitamina B12.
- Los anticuerpos positivos contra el factor intrínseco confirmaron la anemia perniciosa.
Principales resultados:
- El paciente presentó anemia macrocítica grave, trombocitopenia y marcadores de hemólisis.
- Se observó una prueba de Coombs negativa y la ausencia de esquistocitos.
- Confirmado grave deficiencia de vitamina B12 y anemia perniciosa.
- La terapia intramuscular con cianocobalamina resultó en una rápida recuperación hematológica.
Conclusiones:
- La anemia perniciosa puede presentarse como anemia hemolítica, con riesgo de diagnóstico erróneo.
- Las claves clave para el diagnóstico incluyen prueba de Coombs negativa, macrocitosis y falta relativa de reticulocitosis.
- La conciencia de las asociaciones autoinmunes, como la tiroiditis de Hashimoto, ayuda al diagnóstico oportuno.
- El reemplazo inmediato de la vitamina B12 es esencial para revertir las anomalías hematológicas y prevenir el daño neurológico.
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