# From vision to vital signs: uncovering severe Anemia through retinal clues!

## TL;DR

A young woman with sudden vision loss was found to have severe anemia, which was diagnosed and treated, leading to partial recovery of vision.

## Contribution

This case highlights the rare but critical presentation of severe anemia as an acute ophthalmic emergency.

## Key findings

- Severe megaloblastic anemia due to vitamin B12 deficiency presented with acute bilateral vision loss and retinal hemorrhages.
- Prompt treatment with blood transfusions and vitamin supplementation led to improved hemoglobin and partial visual recovery.
- Fundus examination revealed Roth spots and retinal hemorrhages, indicative of anemic retinopathy.

## Abstract

A 28-year-old woman presented in the emergency with sudden, painless bilateral loss of vision over one week. Fundus examination revealed multiple white-centered retinal hemorrhages (Roth spots), cotton wool spots, and multiple retinal hemorrhages in both eyes, indicative of anemic retinopathy. Laboratory evaluation showed profound pancytopenia: hemoglobin 2.3 g/dl, leukocyte count 3.0 × 10^9/l, platelet count 92 × 10^9/l, with elevated mean corpuscular volume (107 fl). Serum cobalamin (vitamin B12) was 57 pg/ml and folate 3.5 ng/ml, consistent with megaloblastic anemia due to vitamin B12 deficiency. Peripheral blood smear confirmed macro-ovalocytes and hypersegmented neutrophils. The patient was managed emergently with packed red blood cell transfusions and parenteral vitamin B 12 and folate supplementation. Two weeks later, her hemoglobin had improved to 10.1 g/dl, and follow-up fundus examination showed marked resolution of retinal hemorrhages and Roth spots with partial visual recovery. This case highlights that severe megaloblastic anemia can present as an acute ophthalmic emergency.