student
Tula, Russian Federation
UDC 61
The article presents a clinical case of a 64-year-old patient with a severe form of anemia that developed due to a combined deficiency of iron and vitamin B12. The pathology was formed against the background of long-term chronic atrophic gastritis and nutritional imbalance. A special feature of this observation is the laboratory picture: normochromic normocytic anemia with pronounced anisocytosis (increased RDW), which made the initial diagnosis difficult and led to the ineffectiveness of previously prescribed iron monotherapy. The article provides a detailed description of the pathophysiological mechanisms underlying the development of combined deficiencies, as well as a comprehensive overview of the full range of clinical manifestations, including hemic, epithelial, neurological (funicular myelosis, polyneuropathy), and cardiovascular syndromes. Attention is paid to the algorithm of differential diagnosis and interpretation of laboratory markers. A step-by-step treatment strategy is described in detail, which involves simultaneous parenteral and oral correction of both deficiency conditions, and the need for lifelong replacement therapy with cyanocobalamin is substantiated. Dynamic monitoring demonstrated the normalization of hematological parameters and a significant regression of neurological symptoms, confirming the effectiveness of the applied comprehensive approach. This case serves as an illustration of the importance of a holistic perception of the patient in order to overcome diagnostic pitfalls in polydeficiency anemias.
Combined anemia, sideropenia, B12 deficiency, atrophic gastritis, funicular myelosis, and differential diagnosis of anemias.
1. Vorob'ev P.A. Anemicheskiy sindrom v klinicheskoy praktike. – M.: N'yudiamed, 2020. – 432 s.
2. Demihov V.G., Morschakova E.F., Rumyancev A.G. Rasprostranennost' i struktura anemiy v gerontologicheskoy populyacii: rezul'taty epidemiologicheskogo issledovaniya // Klinicheskaya gerontologiya. – 2021. – T. 27, № 3-4. – S. 12-18.
3. Lifshic V.M., Sidel'nikova V.I. Vitaminno-mineral'naya nedostatochnost' u vzroslyh: diagnostika i korrekciya. – M.: Medicinskoe informacionnoe agentstvo, 2023. – 264 s.
4. Cappellini M.D., Musallam K.M., Taher A.T. Iron deficiency anemia revisited // Journal of Internal Medicine. – 2020. – Vol. 287, № 2. – P. 153-170.
5. Kazakova L.M., Horoshilov S.E. Sochetannyy deficit zheleza i vitamina V12: slozhnosti diagnostiki i lecheniya // Klinicheskaya medicina. – 2023. – T. 101, № 1. – S. 45-51.
6. Maev I.V., Dicheva D.T., Andreev D.N. Zhelezodeficitnaya anemiya v praktike gastroenterologa // RZhGGK. – 2019. – T. 29, № 4. – S. 71-80.
7. Sheptulin A.A., Kopchenova I.A. Hronicheskiy atroficheskiy gastrit kak mezhdisciplinarnaya problema // RZhGGK. – 2021. – T. 31, № 6. – S. 14-20.
8. Gusev E.I., Nikogosyan A.S., Geht A.B. Nevrologicheskie proyavleniya deficita vitamina V12: klinicheskie osobennosti i lechenie // Nevrologicheskiy zhurnal. – 2022. – T. 27, № 2. – S. 60-68.
9. Green R., Allen L.H., Bjørke-Monsen A.L. et al. Vitamin B12 deficiency // Nature Reviews Disease Primers. – 2017. – Vol. 3. – P. 17040.
10. Patofiziologiya eritrona: rol' anizocitoza (RDW) v differencial'noy diagnostike anemiy / Pod red. V.M. Delyagina. – SPb.: SpecLit, 2020. – 112 s.
11. Belousova A.A., Muhina A.A. Kachestvo zhizni pacientov s anemiey do i posle patogeneticheskoy terapii // Terapiya. – 2023. – № 5(59). – S. 102-109.
12. Snezhko E.V., Agafonova E.V. Dinamika kliniko-laboratornyh pokazateley u pacientov s sochetannoy anemiey na fone terapii // Gematologiya i transfuziologiya. – 2022. – T. 67, № S1. – S. 45-46.
13. Rumyancev A.G., Korovina N.A., Chernov V.M. Zhelezodeficitnye anemii: rukovodstvo dlya vrachey. – M.: GEOTAR-Media, 2022. – 176 s.
14. Strutynskaya E.V., Baranovskaya E.A. Megaloblastnye anemii: ot diagnostiki k terapii // Medicinskiy sovet. – 2020. – № 17. – S. 78-85.
15. Zayrat'yanc O.V., Kakturskiy L.V., Nikitin A.G. Diagnosticheskie oshibki v terapii (na primere anemicheskogo sindroma). – M.: Prakticheskaya medicina, 2021. – 144 s.
