Hypersegmented neutrophils and reversible hyperpigmentation in vitamin B12 deficiency in Ghana

The present report concerns three cases of vitamin B12 deficiency in Ghana. One case presented in the expected textbook manner with neurological signs, anaemia and a low serum vitamin B12 level, whereas another presented with anaemia and hyperpigmentation, but a high serum vitamin B12 level. Both responded well to treatment with vitamin B12. It is suggested from the literature that the high serum vitamin B12 may have been the result of high intrinsic factor antibodies. The third patient presented with haemolytic anaemia with depression, and was managed as such initially. She responded well, with a normalisation of haemoglobin levels. Persisting vague neurological symptoms lead to a check of serum vitamin B12, which was found to be low. Her symptoms cleared with vitamin B12 treatment. The need for a pragmatic approach in diagnosing vitamin B12 deficiency is stressed.