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Vitamin C deficiency: rare cause of severe anemia with hemolysis

  • Hira ShaikhEmail author
  • Muhammad Salman Faisal
  • Prerna Mewawalla
Case Report
  • 56 Downloads

Abstract

Historically known to be a disease of sailors and soldiers in the seventeenth and eighteenth century, scurvy is a rare nutritional deficiency in the developed world, but it can still be seen among the alcoholics and the malnourished. We present a case of a 39-year-old alcoholic male who presented with progressive fatigue and diffuse purpuric rash with scattered ecchymosis for 2 months. Blood work was remarkable for hemoglobin of 9.1 g/dl, which further dropped to 7 g/dl over the next few days. He was then found to have hemolysis on lab work. After an extensive workup, the common causes of hemolytic anemia were ruled out, vitamin C level was checked, which interestingly resulted as 0 mg/dl. Supplementation with oral vitamin C resulted in the gradual resolution of hemolytic anemia and rash. Hemoglobin improved to 15 g/dl in 4 weeks, with normalization of vitamin C level. The clinical features of scurvy can easily be confused with conditions such as vasculitis, deep venous thrombosis, and systemic bleeding disorders. Therefore, comprehensive workup up is required prior to the diagnosis. Although rare, being a reversible condition, early diagnosis and treatment of scurvy in high-risk populations cannot be stressed enough.

Keywords

Scurvy Hemolytic anemia Vitamin C deficiency Rash Petechia 

Abbreviations

aPTT

Activated partial thromboplastin time

RBC

Red blood cell

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests to disclose.

References

  1. 1.
    Fazio V, Flint DM, Wahlqvist ML. Acute effects of alcohol on plasma ascorbic acid in healthy subjects. Am J Clin Nutr. 1981;34(11):2394–6.CrossRefGoogle Scholar
  2. 2.
    Leung FW, Guze PA. Adult scurvy. Ann Emerg Med. 1981;10(12):652–5.CrossRefGoogle Scholar
  3. 3.
    Malmauret L, Leblanc J, Cuvelier I, Verger P. Dietary intakes and vitamin status of a sample of homeless people in Paris. Eur J Clin Nutr. 2002;56(4):313–20.CrossRefGoogle Scholar
  4. 4.
    Fraser IM, Dean M. Extensive bruising secondary to vitamin C deficiency. BMJ Case Rep. 2009.  https://doi.org/10.1136/bcr.08.2008.0750.Google Scholar
  5. 5.
    Reuler JB, Broudy VC, Cooney TG. Adult scurvy. Jama. 1985;253(6):805–7.CrossRefGoogle Scholar
  6. 6.
    Major RH, A history of medicine. A history of medicine. Charles C. Thomas; 1954.Google Scholar
  7. 7.
    Lind J, A treatise on the scurvy: in three parts, containing an inquiry into the nature, causes, and cure, of that disease. A. Millar; 1757.Google Scholar
  8. 8.
    Smith A, Di Primio G, Humphrey-Murto S. Scurvy in the developed world. Cmaj. 2011;183(11):E752-5.CrossRefGoogle Scholar
  9. 9.
    Lau H, Massasso D, Joshua F. Skin, muscle and joint disease from the 17th century: scurvy. Int J Rheum Dis. 2009;12(4):361–5.CrossRefGoogle Scholar
  10. 10.
    Padayatty SJ, Levine M. New insights into the physiology and pharmacology of vitamin C. Cmaj. 2001;164(3):353–5.Google Scholar
  11. 11.
    Baradhi KM, Vallabhaneni S, Koya S. Scurvy in 2017 in the USA. Proc (Bayl Univ Med Cent). 2018;31(2):227–8.CrossRefGoogle Scholar
  12. 12.
    Cox EV. The Anemia of Scurvy. In: Harris RS, Wool IG, Loraine JA, Thimann KV (eds). Vitamins & hormones. Cambridge: Academic Press, 1969, pp 635–652.Google Scholar
  13. 13.
    Goldberg A. The anaemia of scurvy. Q J Med. 1963;32:51–64.Google Scholar
  14. 14.
    Stefanini M, Dameshek W. The hemorrhagic disorders. New York: Grune & Stratton. Inc; 1955.Google Scholar
  15. 15.
    Merskey C. Survival of transfused red cells in scurvy. Br Med J. 1953;2(4850):1353–6.CrossRefGoogle Scholar
  16. 16.
    Yalcin A, Ural AU, Beyan C, Tastan B, Demiriz M, Cetin T. Scurvy presenting with cutaneous and articular signs and decrease in red and white blood cells. Int J Dermatol. 1996;35(12):879–81.CrossRefGoogle Scholar
  17. 17.
    Vilter RW, Woolford RM, Spies TD. Severe scurvy; a clinical and hematologic study. J Lab Clin Med. 1946;31:609–30.Google Scholar

Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineAllegheny Health NetworkPittsburghUSA
  2. 2.Department of Hematology-OncologyAllegheny Health NetworkPittsburghUSA

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