有害な真実を明らかにする: 深刻なビタミンB12欠乏症の希少なプレゼンテーションに関するケースレポート
Olawale O Akinola1, Anvitha Mandapati2, Nathan Douthit1
1Internal Medicine, East Alabama Medical Center, Opelika, USA.
Cureus
|February 20, 2026
まとめ
自己免疫性疾患である悪性貧血は,血液溶解性貧血を模倣し,誤診につながる可能性があります. 早期のビタミンB12補充は,血液学的回復と神経学的損傷の予防に不可欠です.
科学分野:
- 血液学 ヘマトロジ
- エンドクリノロジー エンドクリノロジー
- 自己免疫学とは,自己免疫学です.
背景:
- ビタミンB12欠乏症は一般的にメガロブラスティック貧血を引き起こす.
- 稀に,血液溶解の特徴を呈し,自己免疫的または微血管病的状態を模倣する.
- B12欠乏症の自己免疫的原因である悪性貧血は,しばしば認識されず,他の自己免疫疾患と関連しています.
研究 の 目的:
- 血液溶解性貧血として現れる悪性貧血の症例を報告する.
- 診断上の課題を強調し,早期の認識と治療を強調する.
主な方法:
- ハシモトの甲状腺炎を患った45歳の女性の症例報告.
- 検査室での評価は,全血球数,周周回スプレー,LDH,ハプトグロビン,クームス検査,G6PD,ビタミンB12レベルなどです.
- 陽性な抗内在因子抗体は,悪性貧血を確認した.
主要な成果:
- 患者は重度のマクロサイト性貧血,血小板減少,および血液溶解マーカーを示した.
- クームズ検査の陰性とシストოციトの欠如が認められた.
- 確認された重度のビタミンB12欠乏症と悪性貧血.
- 肌内シアノコバラミン療法により,血液学的回復が迅速になりました.
結論:
- 破滅性貧血は,血解性貧血として現れ,誤診のリスクがあります.
- 診断の鍵となる手がかりは,陰性Coombsテスト,マクロサイトーシス,およびレチキュロサイトーシスの相対的欠如である.
- ハシモトの甲状腺炎のような自己免疫関連性の認識は,早期診断を助けます.
- 迅速なビタミンB12補充は,血液学的異常を逆転させ,神経学的損傷を防ぐために不可欠です.
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