{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T05:27:32Z","timestamp":1767245252989,"version":"3.44.0"},"reference-count":12,"publisher":"SMC Media","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Before the development of transfusion medicine, severe anaemia was an important cause of morbidity and mortality. The discovery of haematopoietic mechanisms and essential nutrients made it possible to easily treat and prevent this condition. Nevertheless, it is often fatal in patients presenting with extreme anaemia (haemoglobin levels &lt;2 g\/dl). We report the rare case of a 54-year-old woman who presented with profound megaloblastic anaemia (haemoglobin of 1.7 g\/dl) due to vitamin B12 deficiency, and was successfully treated.<\/jats:p>","DOI":"10.12890\/2021_002357","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T09:52:37Z","timestamp":1621936357000},"source":"Crossref","is-referenced-by-count":1,"title":["Surviving Extreme Anaemia"],"prefix":"10.12890","volume":"8","author":[{"given":"Joana","family":"Esteves","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5402-242X","authenticated-orcid":false,"given":"Joana","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine Department, Centro Hospitalar e Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-4139","authenticated-orcid":false,"given":"Pedro","family":"Oliveira-Monteiro","sequence":"additional","affiliation":[{"name":"Clinical Hematology Department, Centro Hospitalar e Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"given":"Mariana","family":"Almeida","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar e Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5519-707X","authenticated-orcid":false,"given":"Lu\u00eds","family":"Nogueira-Silva","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar e Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1337-7179","authenticated-orcid":false,"given":"Jorge","family":"Almeida","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar e Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal; Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal"}]}],"member":"10397","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"10.12890\/2021_002357_ref1","doi-asserted-by":"crossref","unstructured":"<li>Roubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: a retrospective cohort study. <em>Ann Intern Med<\/em> 2019;<strong>170<\/strong>(2):81\u201389.<\/li>","DOI":"10.7326\/M17-3253"},{"key":"10.12890\/2021_002357_ref2","unstructured":"<li>NICE. Blood transfusion, NICE guideline [NG24] Published date: 18 November 2015. Available from https:\/\/www.nice.org.uk\/guidance\/ng24<\/li>"},{"key":"10.12890\/2021_002357_ref3","doi-asserted-by":"crossref","unstructured":"<li>Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. <em>JAMA<\/em> 2019;<strong>321<\/strong>(10):983\u2013997.<\/li>","DOI":"10.1001\/jama.2019.0554"},{"key":"10.12890\/2021_002357_ref4","doi-asserted-by":"crossref","unstructured":"<li>Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. <em>Transfusion<\/em> 2002;<strong>42<\/strong>(7):812\u2013818.<\/li>","DOI":"10.1046\/j.1537-2995.2002.00123.x"},{"key":"10.12890\/2021_002357_ref5","doi-asserted-by":"crossref","unstructured":"<li>Stabler SP. Vitamin B12 deficiency. <em>N Engl J Med<\/em> 2013;<strong>368<\/strong>(2):149\u2013160. <\/li>","DOI":"10.1056\/NEJMcp1113996"},{"key":"10.12890\/2021_002357_ref6","doi-asserted-by":"crossref","unstructured":"<li>Scott JM, Molloy AM. The discovery of vitamin B12. Ann Nutr Metab 2012;61:239\u2013245.","DOI":"10.1159\/000343114"},{"key":"10.12890\/2021_002357_ref7","doi-asserted-by":"crossref","unstructured":"<li>Minot GR, Murphy WP. Treatment of pernicious anemia by a special diet. <em>J Am Med Assoc<\/em> 1926;<strong>87<\/strong>(7):470\u2013476.<\/li>","DOI":"10.1001\/jama.1926.02680070016005"},{"key":"10.12890\/2021_002357_ref8","doi-asserted-by":"crossref","unstructured":"<li>Castle WB, Ham TH. Landmark article Oct 31, 1936: Observations on the etiologic relationship of achylia gastrica to pernicious anemia. V. Further evidence for the essential participation of extrinsic factor in hematopoietic responses to mixtures of beef muscle and gastric juice and to hog stomach mucosa. By W.B. Castle and T.H. Ham. <em>JAMA<\/em> 1984;<strong>251<\/strong>(4):514\u2013521. <\/li>","DOI":"10.1001\/jama.1984.03340280064034"},{"key":"10.12890\/2021_002357_ref9","doi-asserted-by":"crossref","unstructured":"<li>MacDonald RM, Ingelfinger FJ, Belding HW. Late effects of total gastrectomy in man. <em>N Engl J Med<\/em> 1947;<strong>237<\/strong>(24):887\u2013896. <\/li>","DOI":"10.1056\/NEJM194712112372401"},{"key":"10.12890\/2021_002357_ref10","doi-asserted-by":"crossref","unstructured":"<li>Williams JA, Baume PE, Meynell MJ. Partial gastrectomy: the value of permanent vitamin-B-12 therapy. <em>Lancet<\/em> 1966;<strong>1<\/strong>(7433):342\u2013344. <\/li>","DOI":"10.1016\/S0140-6736(66)91323-7"},{"key":"10.12890\/2021_002357_ref11","unstructured":"<li>Lindgren A, Lasson A. [Hb 17g\/1! The patient survived without obvious sequelae. A case report of extreme pernicious anemia]. <em>Lakartidningen<\/em> 2008;<strong>105<\/strong>(43):3015\u20133017. <\/li>"},{"key":"10.12890\/2021_002357_ref12","doi-asserted-by":"crossref","unstructured":"<li>Shiraishi W, Une H, Iwanaga Y, Yamamoto A. A case of post-transfusion posterior reversible encephalopathy syndrome with cerebral hemorrhage that may be associated with fat-soluble vitamin deficiency. <em>Clin Neurol<\/em> 2014;<strong>54<\/strong>(6):518\u2013521. <\/li>","DOI":"10.5692\/clinicalneurol.54.518"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2357\/2586","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2357\/2587","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2357\/2587","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:12:09Z","timestamp":1756372329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/2357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,5]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.12890\/2021_002357","relation":{"has-manifestation":[{"id-type":"other","id":"1-69-2357-g2586","asserted-by":"subject"},{"id-type":"other","id":"1-69-2357-g2587","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-69","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2021,3,5]]},"article-number":"25"}}