A Case of B12 Deficiency Diagnosed at a Primary Care Outpatient Clinic

Abstract

Vitamin deficiency is an important public health problem. In this study, it was aimed to demonstrate a case with vitamin B12 deficiency and discuss differential diagnosis. A 69-year-old male patient admitted to our primary care outpatient clinic with excessive fatigue, weight loss, jaundace of the eyes, and impaired balance for 4-5 months. Retired, lonely patient did not report alcohol or smoking. There was no known chronic illness. Physical examination revealed that the patient had cachexia and scleral icteria, the liver was palpabl 2 cm. under the costal margin, and there were wheezes in the lungs. Pancytopenia and MCV elevation were present in the blood tests of the patient. Other blood tests, abdominal ultrasonography and direct coombs test were normal. Blood transfusion was performed and 1000 mcg B12 vitamin (cyanocobalamin) and 5 mg folic acid treatment were started. As the patient was older than 65 years and gave a story of living alone, it was diagnosed as Vitamin B12 deficiency because of the nutritional reasons. This case was presented because it was a demostratative and instructive example of Vitamin B12 deficiency which is one of the most common community health problems.