A case report published in Cureus describes two middle-aged women with severe combined vitamin B12 and folate deficiency whose lab results initially looked similar to hemolytic anemia. According to the report title and summary, both patients were long-term proton pump inhibitor users and presented with symptomatic macrocytic anemia.
The report highlights how megaloblastic anemia can create diagnostic confusion when it is accompanied by biochemical findings often associated with hemolysis. In these cases, markedly elevated lactate dehydrogenase (LDH) and other abnormal results appear to have complicated the initial clinical picture.
The authors point to severe deficiency of both vitamin B12 and folate as the underlying problem, rather than a primary hemolytic disorder. That distinction matters because the treatment approach and the long-term follow-up differ significantly once the correct cause of anemia is identified.
The case report also draws attention to long-term proton pump inhibitor use as an important part of the patients’ history. While a case report cannot prove cause and effect, it underscores the need to consider nutritional deficiencies in people with prolonged PPI exposure who develop macrocytic anemia or lab features that seem to suggest hemolysis.
