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Case Reports: Reminder of important clinical lesson
Spontaneous haematomas and haematochezia due to vitamin C deficiency in a haemodialysis patient
  1. James Q Zhou1,2,
  2. Marko Velimirovic1,2,
  3. Leslie L Chang1,2 and
  4. Andrew Z Fenves1,3
  1. 1Harvard Medical School, Boston, Massachusetts, USA
  2. 2Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Clinician Educator, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Marko Velimirovic; marqobg{at}yahoo.com

Abstract

A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.

  • Haematology (incl blood transfusion)
  • Malnutrition
  • Vitamins and supplements
  • Dialysis

https://doi.org/10.1136/bcr-2022-249711

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    Footnotes

    • Twitter @marko_velimir

    • Contributors JQZ: conception, analysis of laboratory data, manuscript writing and editing. MV: conception, data collection, analysis of laboratory data, manuscript writing and editing, taking patient photographs, obtaining patient consent. LLC: conception, data collection, analysis of laboratory data, manuscript writing and editing, taking patient photographs. AZF: obtaining patient consent, editing and final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.