A 64-year-old man with history of chronic anemia and dyspepsia presented with fatigue, exertional chest pain, pedal edema and dyspnea for 2weeks. His temperature was 37o C, heart rate 74/min, blood pressure was 133/66mmHg, respiratory rate 18/min, and SpO2 of 96% on ambient air. Laboratory studies showed hemoglobin of 2.73mmol/L (Normal: 8.56–10.67mmol/L), mean corpuscular volume (MCV) of 123fL, platelet count on 32×109/L and white blood cell count of 2.8×109/L. His indirect bilirubin was 47.9μmol/L (normal <18μmol/L), lactate dehydrogenase was 104.7 μkat/L (normal: 1.4–4.1μkat/L), reticulocyte count was 1.2%, haptoglobin level was <3.65μmol/L (normal 3.76–25.17μmol/L) folic acid level was 40.7nmol/L (normal, >9.1nmol/L), vitamin B12 was 89.9pmol/L (normal, >221pmol/L).
