Abstract

 Introduction: Auto immune haemolytic anemias are caused by antibody production by the body against its own RBCs. They are characterised by a positive direct anti globulin test and divided into warm and cold types. Vitamin B12 deficiency associated with Auto immune hemolytic anemia  leads to  severe complications such as severe anemia, pancytopenia, and rarely hemolysis.  
Case presentation:A  37 year old male presented with c/o breathlessness, yellowish discolouration of eyes, oral ulcers, generalised fatigue, decreased appetite for 3 weeks. Clinical examination was unremarkable except for pallor, icterus and oral ulcers. Lab reports revealed severe anemia with peripheral smear  Peripheral smear showed macrocytic normochromic anemia, hypersegmented neutrophils, cabot rings with hemolysis features. S.Folate and B12 levels were Low.Direct Coomb’s test was positive. LFT revealed Indirect Hyper Bilirubinemia, Increased LDH. Patient treated with PRBC transfusion and Inj.Vitamin B12 intra venously .On follow up patient symptoms got improved .
Conclusion:  Macrocytic anemia presented with Hemolysis is rare in occurence.The fact that patients anemia resolved after vitamin B12 treatment indicates a possibility of vitamin B12 Deficiency causing AIHA