Pseudo-thrombotic thrombocytopenic purpura: A rare presentation of pernicious anemia

Tadakamalla, Ashvin; Talluri, Siva; Besur, Siddesh

doi:10.4297/najms.2011.3472.

Cited by 34 publications

(24 citation statements)

References 7 publications

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“…3,11,12 Also, biliary cobalamin can be reabsorbed through the enterohepatic system and stored in the liver. 11 Dietary cobalamin deficiency is rare in developed countries 11,13,15 with the exceptions of malnourished and vegetarian/vegan populations. 3,11,15 Absorption can also be effected by medication effect limiting gastric and pancreatic acid or altered microbiota.…”

Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

“…3,7,11,12 Deficiency impairs DNA synthesis delaying migration of the DNA replication fork and annealing DNA fragments of the lagging strand, arresting maturation of hematopoietic cell precursors. 6,8,9,11,16 This creates ineffective erythropoiesis by intramedullary apoptosis in the marrow, but intravascularly, the asynchronous maturation of nucleus and cytoplasm create large erythrocytes with rigid but fragile cell membranes, 3,6,10,11,13,14,15,16 prone to hemolysis with sheering stress (Figure 2). Homocysteine accumulation causes that stress with endothelial damage, vasoconstriction, activation of the coagulation system and platelet aggregation.…”

Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

“…Homocysteine accumulation causes that stress with endothelial damage, vasoconstriction, activation of the coagulation system and platelet aggregation. 3,6,7,10,13,14,15 WVMJ OA Case Report | This combined pathology results in pseudo-TTP. Plasma infusions and plasma exchange do little to treat pseudo-TTP.…”

Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

“…Cobalamin deficiency related TMA, which accounts for 2.5% of all TMA cases and called pseudo-TTP. 13 Understanding the differences between TTP and pseudo-TTP is essential for rapid diagnosis, allowing for appropriate treatment and minimizing potential harm to the patient.…”

Section: Introductionmentioning

confidence: 99%

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

Franks¹,

Jarrell²,

MD³

et al. 2018

WVMJ

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A thrombotic microangiopathy (TMA) occurs when a patient presents with microangiopathic hemolytic anemia, thrombocytopenia and organ damage. There are many causes of TMAs, but thrombotic thrombocytopenic purpura (TTP) must always be considered because of its high mortality rate. Treatment with therapeutic plasma exchange and transfusions can reduce the mortality rate but those treatments carry their own morbidity. Severe cobalamin deficiency can cause a clinical picture similar to TTP. Understanding the pathologic changes of this pseudo-TTP can allow physicians to suspect this difference early in the clinical course. In the following case, elevations in homocysteine and methylmalonic acid, as well as changes in the CBC, allowed this distinction to be identified early, minimizing potentially dangerous treatments.

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Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

Section: Cobalamin Physiology and Pathophysiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Franks¹,

Jarrell²,

MD³

et al. 2018

WVMJ

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show abstract

“…A kobalamin E és G betegséghez kapcsolódó aHUS-t is közöltek már. Nagyon ritkán az anaemia perniciosa [79] is járhat microangiopathiás vérképpel. A klinikai kép azonban inkább TTP-nek felel meg, az aránytalanul magas LDH hívhatja fel rá a figyelmet, az alacsony serum-B12-vitamin-szint és a normális ADAMTS13-aktivitás pedig segít az elkülönítésben.…”

Section: Defektív Kobalamin C-metabolizmus Okozta Husunclassified