Grave and pernicious anemia presenting as pancytopenia

A 74 year-old woman was brought to the emergency department because of general weakness and shortness of breath lasting for 3-4 weeks. She fell at home and could not get up because of a lack of muscular strength. Moreover, she noticed mild paresthesia in her arms and legs. Prostration caused her to stop taking her antihypertensive medication. She reported a weight loss of 12 kg in the last 2 years without fever or night sweats. Her bowel movements were unremarkable and she noticed no blood in the stool.