Type I Dyserythropoietic Anemia in an Elderly Patient

A woman born in September 1912 was examined at the Mayo Clinic in March 1971. She had a history of chronic anxiety state and functional fatigue. For at least 35 yr she had been mildly anemic, and various treatments given elsewhere, including iron, liver extract, and vitamin B,2, had not helped her. Fifteen years before her present admission she had had a bone marrow study that was interpreted as “suggestive of pernicious anemia.” The family history was negative for blood dyscrasias. A cholecystectomy had been performed in 1955 for cholelithiasis; she was not jaundiced. Her breasts had been removed, one 15 and one 18 yr before, because of cancer; no recurrences were noted. Results of the physical examination were not remarkable, except for atrial fibrillation. The spleen and liver were not palpable. The hemoglobin level was 10.8 g/dl; erythrocyte count was 3,010,000/cu mm, and leukocyte count was 6400 cu/mm, with a normal differential count. The platelet count was 216,000 cu/mm, and the reticubocyte count was 2.1%. Marked anisopoikibocytosis, with significant oval macrocytosis and prominent basophilic stippling, was seen on a peripheral blood smear. Free gastric hydrochloric acid was present. The serum levels of vitamin B,2 and folate were normal. The serum iron level was 117 g/d1, and the total iron-binding capacity was 169 g/dl, with 69#{176},, saturation. Between 1971 and December 1973, the patient did well, and the hemoglobin level has remained stable.