A Rare Presentation of Pernicious Anemia Manifesting as Disseminated Intravascular Coagulation
Bibliographic record
Abstract
Pernicious anemia is an autoimmune disorder that is characterized by the presence of autoantibodies to intrinsic factor and parietal cells which results in the inability to absorb vitamin B12. It is the most common manifestation of vitamin B12 deficiency and accounts for 20-50% of cases. Disseminated intravascular coagulation (DIC) is a clinical condition that is a complication of another process which causes the activation of coagulation. A 63-year-old female with a history of hypothyroidism presented with a 1-month history of worsening fatigue, intermittent epigastric pain, nausea, vomiting, and diarrhea. Initial laboratory findings showed severe anemia and macrocytosis with a hemoglobin of 4.3 g/dL and a mean corpuscular volume (MCV) of 138 fL. There was also a significant elevation of the D-dimer, lactate dehydrogenase (LDH), and creatinine. She received three units of packed red blood cells (pRBCs) and fluid resuscitation. A vitamin B12 level was obtained which revealed a severe vitamin B12 deficiency (< 150 pg/mL). Additional workup showed seropositivity for anti-parietal cell antibodies and intrinsic factor blocking antibodies, and an esophagogastroduodenoscopy (EGD) biopsy yielded histologic findings consistent with autoimmune gastritis. She was treated acutely with daily intramuscular B12 injections with improvement in hematologic derangements and symptomatology. Arrested erythropoiesis can lead to apoptosis and the high proliferation of immature erythroblasts results in cells that are more susceptible to impaired deoxyribonucleic acid (DNA) synthesis and results in denatured DNA. Pernicious anemia manifesting as DIC has yet to be described in the literature. Here we describe an interesting case of pernicious anemia manifesting as early DIC resulting from arrest of erythropoiesis evidenced by the international society on thrombosis and hemostasis score of 5, diagnostic for DIC. Early recognition and treatment of this reversible etiology of DIC is essential to the improvement of patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".