Anemia Secondary to Vitamin D Intoxication
Authors: Jaume Puig
Journal: Annals of Internal Medicine (1998)

Letters1 April 1998Anemia Secondary to Vitamin D IntoxicationJaume Puig, MD, Rosa Corcoy, MD, PhD, and Jose Rodriguez-Espinosa, MD, PhDJaume Puig, MDHospital de Sant Pau; Barcelona, SpainSearch for more papers by this author, Rosa Corcoy, MD, PhDHospital de Sant Pau; Barcelona, SpainSearch for more papers by this author, and Jose Rodriguez-Espinosa, MD, PhDHospital de Sant Pau; Barcelona, SpainSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-7-199804010-00028 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Anemia is not usually mentioned as a complication of vitamin D intoxication but has been described in patients with and without renal failure [1]. We report on a woman with vitamin D intoxication and anemia not caused by renal failure.A 66-year-old woman was admitted to the emergency department with hypercalcemia diagnosed after 3 weeks of severe constitutional symptoms. Three years earlier, osteoporosis had been diagnosed and a rheumatologist had prescribed an extemporaneous formulation (200 IU of vitamin D and 1 g of calcium glucobionate twice daily), which was prepared by a pharmacist. Blood tests at admission showed a calcium level of 4.04 mmol/L, a hemoglobin concentration of 103 g/L, a urea concentration of 11.2 mmol/L, and a creatinine level of 146 µmol/L. After rehydration, the hemoglobin concentration decreased to 83 g/L. Anemia was nonspecific and nonregenerative, and results of additional tests (chest radiography, mammography, abdominal ultrasonography, bone scintigraphy, fibrogastroscopy, and colonoscopy) were normal. Parathyroid hormone was undetectable, and the plasma 25-hydroxyvitamin D level was 696 nmol/L (normal range, 15 to 125 nmol/L). Two months later, while the patient was receiving a milk-free diet, plasma 25-hydroxyvitamin D levels were high, serum calcium levels were normal, and anemia had resolved. Symptoms had begun roughly when a new bottle of pills with a vitamin D content of 200 µg (8000 IU) was started.The association of hypercalcemia and anemia suggested a neoplastic origin; this idea was rejected when results of additional examinations became available. High vitamin D levels could directly affect hematopoietic cells [2] or act through high calcium levels, which inhibit erythroid colony formation in vitro [3] and erythropoietin production in vitro [4] and in vivo [5]. That calcium is more important than vitamin D itself is supported by the course of our patient, whose anemia subsided after normalization of calcium levels, despite high vitamin D levels.In addition to the danger of extemporaneous formulations, which carry a higher risk for error than factory-made pills, anemia is another potential complication of vitamin D intoxication.References1. Scharfman WB, Proop S. Anemia associated with vitamin D intoxication. N Engl J Med. 1956; 255:1207-12. Google Scholar2. Reichel H, Koeffler HP, Norman AW. Production of 1a,25-dihydroxyvitamin D3 by hematopoietic cells. Prog Clin Biol Res. 1990; 332:81-97. Google Scholar3. Misiti J, Spivak JL. Erythropoiesis in vitro. J Clin Invest. 1979; 64:1573-9. Google Scholar4. Nagakura K, Ueno M, Brookins J, Beckman BS, Fisher JW. Effects of low calcium levels on erythropoietin production by human renal carcinoma cells in culture. Am J Physiol. 1987; 253:797-801. Google Scholar5. McGonigle RJ, Brookins J, Pegram BL, Fisher JW. Enhanced erythropoietin production by calcium entry blockers in rats exposed to hypoxia. J Pharmacol Exp Ther. 1987; 241:428-32. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Hospital de Sant Pau; Barcelona, Spain PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIatrogenic vitamin D toxicity in an infant – a case report and review of literatureQuantitative Changes in Blood CellsMacronutrientsA Vegetarian DietVitamin D overdose 1 April 1998Volume 128, Issue 7Page: 602-603KeywordsAnemiaAttentionBlood plasmaCalciumHemoglobinHypercalcemiaIntoxicationRenal failureUreaVitamin D Issue Published: 1 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...