Suspected Metformin-induced Cobalamin Deficiency Mimicking Thrombotic Thrombocytopenic Purpura

Hussain, Syed Ather; Din, Mohammad Ammad Ud; Boppana, Leela Krishna Teja; Kapoor, Ankita; Jamshed, Saad

doi:10.7759/cureus.6921

Cited by 3 publications

(4 citation statements)

References 12 publications

(22 reference statements)

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“…A case of suspected metformin induced cobalamin deficiency (MICD) causing pseudo thrombotic thrombocytopenic purpura was identified as cause of cobalamin deficiency in a 36-year-old female with type 2 diabetes mellitus on metformin for eight years who presented with hemolytic anemia, thrombocytopenia, schistocytes, and mild acute renal failure was studied by Hussain et al [ 28 ]. On admission, laboratory investigations revealed very low serum Vitamin B 12 levels 91 pg/mL, Hb 3.7 g/dl, and MCV 95.6 fL.…”

Section: Vitamin B 12 and Anemiamentioning

confidence: 99%

“…Hussain et al[28].Full blood profile, Vitamin B 12 , Folate, Haptoglobin, MMA, Intrinsic factor antibody At six-month follow-up clinical and laboratory analysis improvement (e.g., hemoglobin improved to 11.9 gm/d).Sasi and Yassin[29].Full blood profile, B 12 level, Bilirubin, LDH Haptoglobin, direct antiglobulin (DAT) Serum iron, thyroid functions Blood cell counts started showing an upward trend on day 4 after starting the treatment. On discharge, after 10 days of hospital stay, improvement of blood profile and vitamin B 12 (from values <37 pmol/L to 369 pmol/L), remission of all symptoms.…”

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confidence: 99%

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A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults

Azzini¹,

Raguzzini²,

Polito³

2021

IJMS

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In the era of evidence-based medicine, the randomized clinical trial corresponds to the top step in the qualitative scale of the evidence available in the literature, while small series of cases or the description of individual cases occupy the last place. However, the latter represent an important part of clinical practice and have significantly influenced the evolution of medicine, contributing significantly to the advancement of scientific knowledge. Vitamin B12 deficiency shares several common symptoms that affect several tissues and organs with health aliments, so its diagnosis could be unobvious for the broad array of its effects and investigation methods used. In this review, we focused our attention on some case reports related to the vitamin B12 deficiency associated to anemia, neurologic disorders, and hyperhomocysteinemia. B12 deficiency reversal is simply achieved by prompt therapy, even though it is not the same for several disorders.

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Section: Vitamin B 12 and Anemiamentioning

confidence: 99%

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confidence: 99%

A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults

Azzini¹,

Raguzzini²,

Polito³

2021

IJMS

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“…Of note, the case reported by Ganipisetti et al also had concomitant thiamine deficiency [ 3 ], while the case reported by Ceuleers et al had concomitant folate deficiency [ 12 ]. Hussain et al reported metformin use as the etiology [ 28 ], and Ricci et al reported human immunodeficiency virus-associated loss of haptocorrin as the etiology [ 45 ]. Chang et al reported celiac disease as a possible etiology [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

Adult Vitamin B12 Deficiency-Associated Pseudo-Thrombotic Microangiopathy: A Systematic Review of Case Reports

Ganipisetti,

Maringanti,

Lingas

et al. 2024

Cureus

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Cobalamin-deficient thrombotic microangiopathy or vitamin B12 deficiency presenting as pseudo-thrombotic microangiopathy is a rare disorder that can be misdiagnosed as thrombotic thrombocytopenic purpura. Patients with this condition are at risk of receiving unnecessary plasmapheresis with a potential delay in appropriate therapy with vitamin B12 supplementation. There are no established diagnostic criteria for this condition in clinical practice. We performed a systematic review of case reports published between January 2018 and January 2023 to analyze the clinical characteristics, risk factors, and patterns of laboratory markers to improve the diagnostic criteria for this condition.

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“…Cobalamin, another B vitamin (B 12 ), participates in many of the same metabolic processes as folate, and deficiencies in either can have overlapping clinical presentations. A clinical entity known as pseudo-thrombotic microangiopathy (pseudo-TMA) has been uniquely linked to B 12 deficiency and has been elucidated in several case reports 3–27…”

Section: Introductionmentioning

confidence: 99%

Pseudo-thrombotic microangiopathy due to folate deficiency

2023

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Classically, deficiencies of vitamin B12and folate are associated with megaloblastic anaemia. Additionally, vitamin B12is able to cause a haemolytic anaemia in the form of pseudo-thrombotic microangiopathy (pseudo-TMA). Here, we present a case of a middle-aged woman with a history of Roux-en-Y gastric bypass who presented with dyspnoea and fatigue and was found to have thrombocytopenia and a non-immune haemolytic anaemia. Work-up for haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, paroxysmal nocturnal haemoglobinuria, infection, malignancy and autoimmune conditions was unremarkable. Her haemolytic anaemia and thrombocytopenia resolved with folate replenishment. She was diagnosed as likely having pseudo-TMA secondary to folate deficiency.

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Suspected Metformin-induced Cobalamin Deficiency Mimicking Thrombotic Thrombocytopenic Purpura

Cited by 3 publications

References 12 publications

A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults

A Brief Review on Vitamin B12 Deficiency Looking at Some Case Study Reports in Adults

Adult Vitamin B12 Deficiency-Associated Pseudo-Thrombotic Microangiopathy: A Systematic Review of Case Reports

Pseudo-thrombotic microangiopathy due to folate deficiency

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