Iron overload as a biochemical and imaging finding of vitamin B12 deficiency

Abstract

Introduction: vitamin B12 deficiency is a common cause of megaloblastic anemia, usually associated with macrocytosis. In some cases, iron overload may be secondary to ineffective erythropoiesis and inappropriate hepcidin suppression mediated by erythroid regulators like erythroferrone and growth differentiating factor 15 (GDF15).

Clinical case: we present the case of a 32-year-old man with megaloblastic anemia and intramedullary hemolysis who was found to have iron overload, with imaging evidence of liver iron deposits and splenomegaly. The findings were interpreted as secondary to ineffective erythropoiesis associated with severe vitamin B12 deficiency.

Conclusion: this case highlights the importance of recognizing iron overload as a reversible manifestation of vitamin B12 deficiency and following up on iron metabolism after treatment due to the subsequent risk of iron deficiency once erythropoiesis is restored.