From vision to vital signs: uncovering severe Anemia through retinal clues!

A 28-year-old woman presented in the emergency with sudden, painless bilateral loss of vision over one week. Fundus examination revealed multiple white-centered retinal hemorrhages (Roth spots), cotton wool spots, and multiple retinal hemorrhages in both eyes, indicative of anemic retinopathy. Laboratory evaluation showed profound pancytopenia: hemoglobin 2.3 g/dl, leukocyte count 3.0 × 10^9/l, platelet count 92 × 10^9/l, with elevated mean corpuscular volume (107 fl). Serum cobalamin (vitamin B12) was 57 pg/ml and folate 3.5 ng/ml, consistent with megaloblastic anemia due to vitamin B12 deficiency. Peripheral blood smear confirmed macro-ovalocytes and hypersegmented neutrophils. The patient was managed emergently with packed red blood cell transfusions and parenteral vitamin B 12 and folate supplementation. Two weeks later, her hemoglobin had improved to 10.1 g/dl, and follow-up fundus examination showed marked resolution of retinal hemorrhages and Roth spots with partial visual recovery. This case highlights that severe megaloblastic anemia can present as an acute ophthalmic emergency.