Severe Low Vitamin B12 Levels with Macrocytosis and Associated Hemolytic Anemia, Mimicking Thrombocytopenic Thrombotic Purpura: A Case Report and Literature Review

Bustos M, Weldt J, Labarca G and Enos D
 

Department of Internal Medicine, University of Concepción, Concepción, Campus Los Angeles, Chile
Center of Undifferentiated Medical Responsibility of Adult Healthcare Dr. Víctor Ríos Ruiz, Chile

^*Correspondance to: Misael Bustos 

 PDF  Full Text Case Report | Open Access

Abstract:

The typical presentation of cobalamin deficiency is macrocytic anemia with or without neurologic symptoms, and the most frequent cause is Pernicious anemia, an autoimmune disease. We present a case of a 61-year-old man with neurologic symptoms, pancytopenia, and laboratory findings consistent with hemolytic Microangiopathic Anemia (MAHA), like Thrombocytopenic Thrombotic Purpura (TTP). The lack of response to Plasma Exchange (PEX) therapy, concomitant with low plasma levels of cobalamin, low reticulocyte count, macrocytosis and remarkably high Lactic Dehydrogenase (LDH) levels made us suspect a Pseudo-Thrombotic Microangiopathy (Pseudo TMA). The diagnosis was confirmed with a normal serum ADAMPTS13 activity and a rapid clinical and laboratory improvement after cobalamin supplementation. We think the internist must know the wide variety of presentations of cobalamin deficiency, since it is a reversible cause of bone marrow failure and its’ misdiagnosis may result in unnecessary costly procedures.

Keywords:

Vitamin B12; Pernicious anemia; Pseudo thrombotic microangiopathy; Thrombocytopenic thrombotic purpura

Cite the Article:

Bustos M, Weldt J, Labarca G, Enos D. Severe Low Vitamin B12 Levels with Macrocytosis and Associated Hemolytic Anemia, Mimicking Thrombocytopenic Thrombotic Purpura: A Case Report and Literature Review. Clin Case Rep Int. 2023; 7: 1613.