Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura
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, indirec...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2021-05-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2021.1893143 |
| _version_ | 1797972225680211968 |
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| author | Pegah Jahangiri Rachel Hicks Prabjot K. Batth Christopher J. Haas |
| author_facet | Pegah Jahangiri Rachel Hicks Prabjot K. Batth Christopher J. Haas |
| author_sort | Pegah Jahangiri |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T03:45:07Z |
| format | Article |
| id | doaj.art-3771bbb8a2e24453a00f500bf5c5e45f |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T03:45:07Z |
| publishDate | 2021-05-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-3771bbb8a2e24453a00f500bf5c5e45f2023-01-02T02:50:32ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662021-05-0111339740310.1080/20009666.2021.18931431893143Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpuraPegah Jahangiri0Rachel Hicks1Prabjot K. Batth2Christopher J. Haas3Medstar HealthSaba University School of MedicineSaba University School of MedicineMedStar HealthBackground: 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.http://dx.doi.org/10.1080/20009666.2021.1893143vitamin b12 deficiencythrombotic thrombocytopenic purpura (ttp)ttp-like syndromepancytopenia |
| spellingShingle | Pegah Jahangiri Rachel Hicks Prabjot K. Batth Christopher J. Haas Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura Journal of Community Hospital Internal Medicine Perspectives vitamin b12 deficiency thrombotic thrombocytopenic purpura (ttp) ttp-like syndrome pancytopenia |
| title | Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| title_full | Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| title_fullStr | Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| title_full_unstemmed | Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| title_short | Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| title_sort | fooled by the fragments vitamin b12 deficiency masquerading as thrombotic thrombocytopenic purpura |
| topic | vitamin b12 deficiency thrombotic thrombocytopenic purpura (ttp) ttp-like syndrome pancytopenia |
| url | http://dx.doi.org/10.1080/20009666.2021.1893143 |
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