Cobalamin Deficient Thrombotic Microangiopathy: a case of TTP or Pseudo-TTP

Franks, Adam M.; Jarrell, Anne; MD, Adrienne Mays,; Bannister, Tammy

doi:10.21885/wvmj.2018.5

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Neurologic issues were not observed in either case presented, with both patients demonstrating a benign neurologic exam. Few case studies discussing pseudo-TTP in the setting of vitamin B12 deficiency mention concomitant neurologic issues, including generalized weakness (potentially attributable to anemia), altered mental status [15][16][17][18] and paresthesia [11,17]. These non-specific findings may be attributable to a combination of hypercoagulability and impaired myelin synthesis.…”

Section: Neurologic Manifestationsmentioning

confidence: 99%

Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura

Jahangiri

Hicks

Batth

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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Background: Thrombotic thrombocytopenic purpura (TTP) is a hematological emergency requiring prompt plasmapheresis. Conversely, vitamin B12 deficiency is a relatively benign diagnosis that can mimic microangiopathic hemolytic anemia, characterized by the presence of anemia, thrombocytopenia, indirect hyperbilirubinemia, markers of hemolysis, and schistocytes. This case series highlights the association of vitamin B12 deficiency and its TTP-like presentations. Cases: The first case describes a 72-year-old man with shortness of breath and weakness. Diagnostics were notable for pancytopenia, schistocytes, and a low reticulocyte index. Intriguingly, total bilirubin was only mildly elevated however LDH and Haptoglobin were elevated and low, respectively. Additional diagnostic workup demonstrated an undetectable B12, elevated methylmalonic acid and elevated homocysteine. Initiation of B12 supplementation resolved his pancytopenia.The second case describes a 57-year-old man with chest tightness, dyspnea on exertion, and night sweats. Diagnostic evaluation demonstrated pancytopenia, schistocytes, a low reticulocyte index, and a remarkably low B12. He had associated high methylmalonic acid and homocysteine levels, confirming the diagnosis. B12 supplementation resolved his pancytopenia. Conclusion:The polysymptomatic presentation of vitamin B12 deficiency-induced pseudothrombotic microangiopathy highlights the vitamin's role in essential physiological cellular functions. Rapid recognition of the underlying etiology of microangiopathic hemolytic anemia is necessary as treatment approaches diverge greatly.

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Section: Neurologic Manifestationsmentioning

confidence: 99%

Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura

Jahangiri

Hicks

Batth

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

Pancytopenia and TTP-like picture secondary to pernicious anaemia

et al. 2020

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A 21-year-old man presented to the emergency department with generalised weakness, weight loss and decreased appetite for few weeks. He had evidence of severe pancytopenia and haemolysis. His peripheral smear with many schistocytes was suspicious for thrombotic thrombocytopenic purpura (TTP). He was supported with blood transfusions and daily plasmapheresis. His platelet counts worsened despite 4 days of therapy. Bone marrow biopsy was significant for hypercellular bone marrow with megaloblastic changes. Further workup revealed normal ADAMTS13 level, low vitamin B12, positive intrinsic factor antibodies and high methylmalonic acid. Diagnosis of pernicious anaemia was established and he was started on daily treatment with intramuscular vitamin B12 which subsequently improved his symptoms and haematological parameters. This report highlights the importance of checking vitamin B12 level in patients presenting with pancytopenia and TTP-like picture before making a diagnosis of TTP.

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Cobalamin Deficient Thrombotic Microangiopathy: a case of TTP or Pseudo-TTP

Cited by 2 publications

References 14 publications

Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura

Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura

Pancytopenia and TTP-like picture secondary to pernicious anaemia

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