Anemia secondary to combined deficiencies of iron and cobalamin
R. B. Hash, M. A. Sargent and H. Katner
Department of Family Medicine, Mercer University School of Medicine, Macon, Ga, USA.
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.
