Hypersegmented neutrophils and reversible hyperpigmentation in vitamin B(12) deficiency in Ghana.

The present report concerns three cases of vitamin B(12) deficiency in Ghana. One case presented in the expected textbook manner with neurological signs, anaemia and a low serum vitamin B(12) level, whereas another presented with anaemia and hyperpigmentation, but a high serum vitamin B(12) level. Both responded well to treatment with vitamin B(12). It is suggested from the literature that the high serum vitamin B(12) may have been the result of high intrinsic factor antibodies. The third patient presented with haemolytic anaemia with depression, and was managed as such initially. She responded well, with a normalisation of haemoglobin levels. Persisting vague neurological symptoms lead to a check of serum vitamin B(12), which was found to be low. Her symptoms cleared with vitamin B(12) treatment. The need for a pragmatic approach in diagnosing vitamin B(12) deficiency is stressed.