A 50 year old woman presented her herself to A+E at her local hospital. She was admitted with severe symptoms of general

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A 50 Year Old Woman Presented Her Herself To A E At Her Local Hospital She Was Admitted With Severe Symptoms Of General 1 (75.22 KiB) Viewed 59 times

A 50 year old woman presented her herself to A+E at her local hospital. She was admitted with severe symptoms of general malaise and a significant loss in weight. She had no signs of palpable lymphendopathy or hepatosplenomegaly. However, there was a history of hypothyroidism and no sign or history of excess alcohol consumption. The patient was not receiving any vitamin B12 supplementation and the bone indicated megaloblastic changes. A range of laboratory tests were performed as stated below: Lab tests Reference Range (115-165 g/L) (80-100 fL) Test Patient's Data Haemoglobin 44 g/L Mean Corpuscular 130 fL Volume (MCV) Haematocrit 0.22 White Cell Count 2.3 x10°/L Platelets 120 x109/L Serum Folate 12 ug/L Vitamin B12 >1500 ng/L Plasma Total 167 umol/L Homocysteine Urinary Methylmalonic 7 umol/mg creatinine acid (MMA) Lactate Dehydrogenase 11500 U/L Haptoglobins 100 mg/L Direct Antiglobulin Test Negative Intrinsic Factor Antibodies >100 U/mL 0.36-0.48 4-11 x 10°/L 150-450 x 10/L 2.5-20 ug/L 190-700 ngL (0-16) umol/L Less than 3.8 pmol/mg creatinine 225-450 U/L 400-1600 mg/L Negative 0-6 U/mL