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Results of a complete blood cell count at presentation showed the following: Hemoglobin 5.5 g/dL (reference range 14.518.1) Hematocrit 17.5% (42.054.0) Mean corpuscular volume 108.7 fL (80100) White blood cell count 3.5 10 9 /L (4.4110.05) Platelet count 54 10 9 /L (150400) Lactate dehydrogenase 3,320 U/L (90285) Haptoglobin 3), homocysteine was elevated at 138 mol/L (0.019.2), and methylmalonic acid was elevated at 25,024 nmol/L (0.0378)