Vitamin C Deficiency Related Cytopenias in Hematology Practice: Revisiting Risk Factors of Access and Income.

Vitamin C (l-ascorbic acid) is an essential dietary micronutrient needed for iron absorption, collagen synthesis, antioxidant activity, and immune regulation. This retrospective analysis examines 23 patients seen in a classical hematology clinic in Appalachia between 2020 and 2025 who had severe vitamin C deficiency (< 0.1 mg/dL). Most patients presented with anemia, fatigue, or other dermatologic findings, and over half lived in food-desert regions. Micronutrient testing often revealed overlapping deficiencies, and 17% of patients experienced a bone marrow biopsy. Principal component analysis of laboratory data identified two main phenotypic clusters: socioeconomic status, which accounted for most of the variability in the data, followed by cell counts and laboratory values. Treatment approaches varied. Normalization of vitamin C levels and cytopenias was seen in patients who attended follow-up, typically within 2-3 months. This work suggests that vitamin C deficiency remains a contemporary and reversible contributor to cytopenias in hematology practice and highlights the importance of dietary and socioeconomic risk assessment during diagnostic evaluation.