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Ahmed Dahshan, MD; Janet Poulick, MD; Vasundhara Tolia, MD
From the Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Oklahoma School of Medicine, Tulsa (Dr Dahshan); and the Department of Pathology (Dr Poulick), Children's Hospital of Michigan (Dr Tolia), Detroit.

Arch Pediatr Adolesc Med. 2001;155:609-610.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 17-YEAR-OLD African American girl was seen for severe anemia. She had mild anemia 1 year previously and increased fatigue and shortness of breath for 3 months prior to evaluation. Her history was notable for insulin-dependent diabetes mellitus (IDDM) since age 6 years, Graves disease with hyperthyroidism since age 13 years, and paranoid schizophrenia since age 14 years. Her maternal grandmother and a maternal aunt had vitamin B₁₂ deficiency, and a brother and maternal aunt had IDDM. Two weeks prior to presentation, our patient developed peripheral edema and cold extremities, consistent with florid congestive heart failure; on examination she had pallor, peripheral edema, and a cardiac gallop with evidence of moderate pulmonary edema. She was paranoid and delusional and had received chlorpromazine hydrochloride, insulin, and sertraline hydrochloride on a regular basis. Peripheral blood (Figure 1) showed profound anisocytosis with . . . [Full Text of this Article]