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We report a B12 deficient female with severe pancytopenia including normocytic anemia who also had enlarged spleen and circulating nucleated red blood cells as well as circulating immature myeloid cells. Although these findings are reported in the earlier literature, more modern reviews of the subject often fail to mention this association. We review the literature on these unusual manifestations of B12 deficiency and remind clinicians that splenomegaly and erythroblastosis can serve as diagnostic clues in cases of severe megaloblastic anemia secondary to B12 deficiency.<\/jats:p>","DOI":"10.1111\/j.1600-0609.2008.01043.x","type":"journal-article","created":{"date-parts":[[2008,4,7]],"date-time":"2008-04-07T04:19:50Z","timestamp":1207541990000},"page":"448-451","source":"Crossref","is-referenced-by-count":18,"title":["Severe vitamin B12 deficiency resulting in pancytopenia, splenomegaly and leukoerythroblastosis"],"prefix":"10.1111","volume":"80","author":[{"given":"Thorvardur R.","family":"Halfdanarson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James A.","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R.","family":"Litzow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Curtis A.","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2008,1,23]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2007.02.013"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2006.02.002"},{"key":"e_1_2_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711133372007"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1031155"},{"key":"e_1_2_3_6_2","first-page":"2061","article-title":"Food cobalamin malabsorption: a usual cause of vitamin B12 deficiency","volume":"160","author":"Andres E","year":"2000","journal-title":"Arch Int Med"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.02.026"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-07-031104"},{"key":"e_1_2_3_9_2","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1093\/clinchem\/46.8.1277","article-title":"Cobalamin and folate evaluation: measurement of methylmalonic acid and homocysteine vs vitamin B(12) and folate","volume":"46","author":"Klee GG","year":"2000","journal-title":"Clin Chem"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.12.1289"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-2712(01)00003-8"},{"key":"e_1_2_3_12_2","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1001\/archinte.1988.00380080016007","article-title":"Pernicious anemia. 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