Rapid Onset of B12 Deficiency in the Setting ofWorsening Multiple Myeloma: Correlations betweenB12 Deficiency and Multiple Myeloma

A 67-year-old female with a relapse of multiple myeloma after being in remission for approximately 2 years following autologousstem cell transplant presented with worsening pancytopenia, over a three-month period. There were an increase in her monoclonalspike at 3.13 g/dL on serum protein electrophoresis, low serum B12 levels, and positive intrinsic factor antibodies. Three monthsbefore, she had normal B12 levels and a significantly lower monoclonal spike of 1.07 g/dL. She was diagnosed with B12 deficiencywith pernicious anaemia in the setting of her worsening myeloma. Multiple myeloma (MM) has been linked with B12 deficiencyand pernicious anaemia. Several mechanisms have been described regarding the pathogenesis of B12 deficiency in such patients.Increased tumour activity can further perpetuate the development of B12 deficiency in such patients. With regard to our case, theincrease in tumour activity and onset of pernicious anaemia could have contributed to the rapid development of B12 deficiency. Incontrast to this, rapid development of B12 deficiency could also signify relapse or worsening of the myeloma as seen in our case.Physicians ought to consider B12 deficiency in patients with worsening pancytopenia and myeloma.