PDF(Pubmed)
Abstract：
Megaloblastic anemia, stemming from vitamin B12 or folate deficiencies, poses diagnostic challenges due to its diverse clinical presentation. We report a case of a 25-year-old female college student presenting with symptoms indicative of megaloblastic anemia, attributed to her recent adoption of a strict vegetarian and vegan diet. Clinical manifestations included dizziness, palpitations, blurred vision, vertigo, headaches, burning sensations, excessive sweating, mouth ulcers, and unintentional weight loss. Physical examination revealed pale palpebral conjunctiva and sweating on the palms and soles. Laboratory findings confirmed megaloblastic anemia secondary to vitamin B12 deficiency, with elevated mean corpuscular volume (MCV), reticulocyte count, serum methylmalonic acid (MMA), and homocysteine levels. Treatment with intramuscular cyanocobalamin injections and oral vitamin B12 supplementation led to symptomatic improvement and normalization of hematological parameters. This case underscores the crucial role of dietary habits in hematological health. Vegetarian and vegan diets, devoid of animal products rich in vitamin B12, increase the risk of deficiency. Early recognition and management of such deficiencies are imperative to prevent long-term complications. A literature review corroborates the association between vegetarianism/veganism and megaloblastic anemia risk. Healthcare providers should vigilantly assess dietary histories, particularly in patients with hematological abnormalities. Further research is warranted to explore strategies for optimizing nutrient intake in individuals adhering to vegetarian or vegan diets, aiming to mitigate the risk of nutritional deficiencies and associated complications.
摘要：
巨幼细胞性贫血,源于维生素B12或叶酸缺乏，由于其多样化的临床表现，提出了诊断挑战。我们报告了一例25岁的女大学生，表现出巨幼细胞性贫血的症状，归因于她最近采用了严格的素食和纯素饮食。临床表现包括头晕，心悸,视力模糊,眩晕,头痛,燃烧的感觉，出汗过多,口腔溃疡,和无意的减肥。体格检查显示眼睑结膜苍白，手掌和脚底出汗。实验室检查结果证实了维生素B12缺乏继发的巨幼细胞性贫血，平均红细胞体积（MCV）升高，网织红细胞计数,血清甲基丙二酸（MMA），和高半胱氨酸水平。用肌肉注射氰钴胺和口服维生素B12补充治疗导致症状改善和血液学参数正常化。该病例强调了饮食习惯在血液健康中的关键作用。素食和素食饮食，缺乏富含维生素B12的动物产品，增加缺乏的风险。这些缺陷的早期识别和管理对于防止长期并发症是必要的。文献综述证实了素食主义/素食主义与巨幼细胞性贫血风险之间的关联。医疗保健提供者应该警惕地评估饮食史，尤其是血液学异常患者。有必要进行进一步的研究，以探索在坚持素食或纯素饮食的个体中优化营养摄入的策略，旨在减轻营养缺乏和相关并发症的风险。
