Vitamin C Deficiency Leading to Hemodynamically Significant Bleeding

Vitamin C deficiency generally results from little to no intake of ascorbic acid, and it often presents with small-volume bleeding. Rarely vitamin C deficiency causes hemodynamically significant bleeding. Here we present a middle-aged man who was admitted to the hospital several times for hypotension, recurring lower extremity ecchymoses, and persistent anemia. Extensive workup from previous hospitalizations did not identify the etiology of his recurrent bleeds. Ultimately a detailed dietary history uncovered a lack of fresh fruit and vegetable intake. Vitamin C deficiency was suspected and subsequently confirmed. After receiving multiple blood transfusions to correct his hypovolemic hypotension, he was treated with high-dose ascorbic acid. This case highlights the potential damage of vitamin C deficiency in the industrialized world, and it reminds clinicians to be vigilant of this rare but significant cause of anemia.