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Abstract

Cobalamin deficiency anemia is a type of anemia that present with weakness, fatigue, icteric sclera and neuropathy. Main causes ofcobalamin deficiency are low intake or decreased absorption (gastric and intestinal causes). In present case, we report a 65-year-old male whopresented to the emergency department with signs and symptoms of cobalamin deficiency including bilateral peripheral neuropathy, icteric skinand sclera, and abdominal pain in right upper quadrant. He had low cobalamin and extremely high bilirubin levels (8mg/dL) in serum. Afterthe diagnosis of cobalamin deficiency established, 1mg daily cobalamin treatment initiated for five days which would follow weekly andmonthly intramuscular injections consequently. Hemolysis and other causes of elevated indirect bilirubin levels were excluded in differentialdiagnosis. Clinical and laboratory improvements were achieved after the treatment. In conclusion, physicians should kept in mind cobalamindeficiency even in subjects with unusual high levels of indirect bilirubin.