Vitamin B12 Deficiency with Pseudothrombotic Microangiopathy and Thrombotic Thrombocytopenic Purpura: Similarities and Differences

Vitamin B12 Deficiency Mimicking Thrombotic Thrombocytopenic Purpura: A Case Report and Review of Literature

“…Additionally, the accumulation of homocysteine disrupts glutathione synthase and leads to an increase in reactive oxygen species, which aggravates RBC integrity [ 4 ]. Thus, relative homocysteinemia caused by vitamin B12 deficiency can cause intramedullary hemolysis [ 7 , 8 ]. Finally, vitamin B12 has been shown to be necessary for myelination in the central nervous system and its deficiency can cause neurological impairment [ 9 ].…”

“…Our patient had a PLASMIC score of 4 (low risk), and so we were able to avoid unnecessary plasmapheresis therapy. However, it is worth noting that there have been several cases of severe vitamin B12 deficiency scoring a 5 or higher (intermediate risk) on the PLASMIC score, indicating the complexity of diagnosis [ 1 , 8 , 18 ].…”

A Case of Pseudothrombotic Microangiopathy Associated with Pernicious Anemia

“…16 Additionally, patients with pseudo-TMA have been shown to have higher median platelet counts and LDH levels compared to those with TTP. 6,16,18 The PLASMIC score is an algorithm that allows investigators to accurately estimate the pre-test probability of TTP from rapidly accessible labs and clinical factors, considering seven variables in patients with evidence of thrombotic microangiopathy. 19,20 In brief, these variables include a low platelet count, evidence of hemolysis, the absence of active cancer, the absence of a stem cell transplant or solid organ transplant, a low MCV, a low international normalized ratio (INR), and a low creatinine level.…”