58-year-old man experiences a six-week decline in health before being diagnosed with a ‘severe’ B12 deficiency

Vitamin B12 is an essential micronutrient that the body needs for nervous and neurological activity. Because the body stores enough nutrients to support its needs for many years, deficiency symptoms may develop slowly. However, untimely correction of the condition can lead to further complications, such as pancytopenia.

In 2019, the Journal of Medical Cases described the case of a 58-year-old man who presented to the emergency room after six weeks of “gradual” worsening of symptoms.

The man’s main complaints were increasing dyspnea on exertion and fatigue, but he also reported intermittent chills and a 15-pound weight loss that was associated with poor appetite.

The patient, who had a history of iron deficiency, gout, and osteoarthritis, denied any risky behavior such as smoking.

He also denied breathing problems but “reported frequent bleeding gums when brushing his teeth,” the report said.

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However, other signs of bleeding, such as epistaxis, melon, and hematuria, were absent.

Doctors drew attention to one of the characteristic features of the patient’s disease – the presence of pancytopenia.

A condition in which there are too few red blood cells, white blood cells, and platelets in the body is not often seen in vitamin B12 deficiency.

According to St. Jude Children’s Research Hospital, this can lead to life-threatening symptoms that affect the entire body if left untreated.


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When platelets are affected, complications typically include excessive bleeding and an increased risk of infection if white blood cells are affected.

These complications usually result from a lack of oxygen or problems with the immune system.

The authors noted, “Pancytopenia occurs in cases of severe vitamin B12 deficiency that persists over time.”

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How does vitamin B12 develop?

The patient was not a vegetarian or vegan, suggesting that the cause of his weight loss was related to B12 malabsorption.

Once stored in the liver, vitamin B12 stores are usually large enough to provide adequate levels for more than five years.

This is why vitamin B12 symptoms are known to develop slowly.

When B12 deficiency occurs, a person is likely to initially experience symptoms such as glossitis, neuropathy, and cognitive dysfunction.

Classically, vitamin B12 deficiency neuropathy presents with symmetrical paresthesias, numbness, or problems with movement. The legs are affected before the arms.

In most cases, these complications can be avoided by providing enough vitamin B12 through the diet.

However, if malabsorption is the cause, patients may need vitamin B12 infections or supplements for support.

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