The article presents a clinical case of a 64-year-old patient with a severe form of anemia that developed due to a combined deficiency of iron and vitamin B12. The pathology was formed against the background of long-term chronic atrophic gastritis and nutritional imbalance. A special feature of this observation is the laboratory picture: normochromic normocytic anemia with pronounced anisocytosis (increased RDW), which made the initial diagnosis difficult and led to the ineffectiveness of previously prescribed iron monotherapy. The article provides a detailed description of the pathophysiological mechanisms underlying the development of combined deficiencies, as well as a comprehensive overview of the full range of clinical manifestations, including hemic, epithelial, neurological (funicular myelosis, polyneuropathy), and cardiovascular syndromes. Attention is paid to the algorithm of differential diagnosis and interpretation of laboratory markers. A step-by-step treatment strategy is described in detail, which involves simultaneous parenteral and oral correction of both deficiency conditions, and the need for lifelong replacement therapy with cyanocobalamin is substantiated. Dynamic monitoring demonstrated the normalization of hematological parameters and a significant regression of neurological symptoms, confirming the effectiveness of the applied comprehensive approach. This case serves as an illustration of the importance of a holistic perception of the patient in order to overcome diagnostic pitfalls in polydeficiency anemias.
N. Carev (Thu,) studied this question.