CASE REPORT: PSUEDO-THROMBOTIC THROMBOCYTOPENIC PURPRA AND COBALAMINE DEFICIENCY.

  • Department of pediatrics, Hematology Oncology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
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Pseudothrombotic microangiopathy is thrombocytopenia, anemia and schistocytosis caused by Cobalamine deficiency. It could be easily misdiagnosed as microangiopathic hemolytic anemia. Evaluation of lactate dehydrogenase, reticulocyte count, peripheral blood smear, platelet count, cobalamine and homocysteine level are crucial for differentiating pseudothrombotic microangiopathy from a true microangiopathic hemolytic anemia. A case of pseudothrombotic microangiopathy due to severe vitamin B12 deficiency is presented.


1. Peigne V, Azoulay E, Coquet I, Mariotte E, Darmon M, Legendre P, Adoui N, Marfaing- Koka A, Wolf M, Schlemmer B, Veyradier A. The prognostic value of ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) deficiency in septic shock patients involves interleukin-6 and is not dependent on disseminated intravascular coagulation. Crit Care. 2013 Nov 18;17(6):R273. 2. Walter K, Vaughn J, Martin D. Therapeutic dilemma in the management of a patient with the clinical picture of TTP and severe B12 deficiency. BMC Hematol. 2015; 1;15:16. 3. Malla M, Seetharam M. To treat or not to treat: a rare case of pseudo-thrombotic thrombocytopenic purpura in a Jehovah's Witness. Transfusion. 2016;56(1):160-3. 4. McCrae KR, Sadler E, Cines DB. Thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. In: Hematology: Basic Principles and Practice, 6th Edition. Elsevier: Philadelphia, PA. 1925-1939 5. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368:149?60. 6. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr 2009;89:693S?6S. 7. Andres E, Affenberger S, Zimmer J, et al. Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haem 2006; 28:50-56. 8. 8- Antony AC. Megaloblastic anemias. In Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology, Basic Principles and Practice, 4th ed. Philadelphia, PA: Elsevier, 2005:519?556 9. 9- Olinescu R, Kummerow FA, Handler B, et al. The hemolytic activity of homocysteine is increased by the activated polymorphonuclear leukocytes. Biochem Biophys Res Commun 1996;226:912?16. 10. Ventura P, Panini R, Tremosini S, et al. A role for homocysteine increase in haemolysis of megaloblastic anemias due to vitamin B12 and folate deficiency: results from an in vitro experience. Biochim Biophys Acta 2004;1739:33?42. 11. No?l N, Maign? G, Tertian G, et al. Hemolysis and schistocytosis in the emergency department: consider pseudothrombotic microangiopathy related to vitamin B12 deficiency. QJM 2013;106:1017?22. 12. Belen B, Hismi BO, Kocak U. Severe vitamin B12 deficiency with pancytopenia, hepatosplenomegaly and leukoerythroblastosis in two Syrian refugee infants: challenge to differentiate from acute leukaemia. BMJ Case Rep 2014;2014. pii: bcr2014203742. 13. Yenicesu I. Pancytopenia due to vitamin B12 deficiency in a breast fed infant. Pediatr Hematol Oncol 2008;25:365?7 14. Citak FE, Citak EC. Severe vitamin B12 deficiency in a breast fed infant with pancytopenia. J Trop Pediatr 2011;57:69?70. 15. Som S, Deford CC, Kaiser ML, Terrell DR, Kremer Hovinga JA, Lammle B, et al. Decreasing frequency plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011. Transfusion. 2012;52(12):2525?32. 16. Dimond A, George JN, Hastings C. Severe vitamin B-12 deficiency in a child mimicking thrombotic thrombocytopenia purpura. Pediatr Blood Cancer 2009;52:420-422. 17. Tuten N, Bennett C, Babcock W. (2015) Thrombotic thrombocytopenic purpura or cobalamin deficiency? A case report and review. Clin Case Rep Rev 1: doi: 10.15761/CCRR.1000152 18. K?m?r M, Bayram I, Erbey F, K?c?kosmanoğlu. A rare cause of thrombocytopenia in infants: Vitamin B12 deficiency. Eur J Gen Med 2010; 7(1): 107?10 19. Volodymyr Shponka, MD; Maria Proytcheva, MD. Megaloblastic anemia caused by severe B12 deficiency in a breastfed infant. 2017 20. Abbott D. W., Friedman K. D., Karafin M. S. Differentiation of pernicious anemia from thrombotic thrombocytopenic purpura: the clinical value of subtle pathologic findings. Transfusion and Apheresis Science. 2016;55(3):318?322. doi: 10.1016/j.transci.2016.08.005 21. T. Panchabhai, P. Patil, E. Riley, and C. Mitchell, ?When the picture is fragmented: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura,? International Journal of Critical Illness and Injury Science, vol. 6, no. 2, pp. 89?92, 2016 22. Tadakamalla AK, Talluri SK, Besur S. Pseudo-thrombotic thrombocytopenic purpura: a rare presentation of pernicious anemia. N. Am. J. Med. Sci. 2011; 3 (10): 472?4. 23. Saroj Kandel, Nibash Budhathoki, Shanta Pandey, Bikash Bhattarai, Aam Baqui, Ramesh Pandey, Divya Salhan, Danilo Enriquez, Joseph Quist and Frances M Schmidt. Pseudo-thrombotic thrombocytopenic purpura presenting as multi-organ dysfunction syndrome: A rare complication of pernicious anemia. SAGE Open Medical Case Reports Volume 5: 1?4 2017 24. 24- Veit K. Pseudothrombotic microangiopathy and vitamin B12 deficiency in pernicious anemia. Proceedings (Baylor University Medical Center). 2017;30(3):346-347. 25. 25- Hassan HH, Al-Shareefy LM. The challenge of microangiopathic hemolytic anemia. Iraqi J Hematol 2017;6:24-5 26. 26- Asano, T., Narazaki, H., Kaizu, K., Matsukawa, S., Takema-Tochikubo, Y., Fujii, S., Saitoh, N., Mashiko, K., and Fujino, O. (2015) Neglect-induced pseudo-thrombotic thrombocytopenic purpura due to vitamin B12 deficiency. Pediatrics International, 57: 988?990. doi: 10.1111/ped.12718. 27. Keskin EY, Keskin M. Severe vitamin B12 deficiency in a 15-year-old boy: presentation with haemolysis and pancytopenia. BMJ Case Reports. 2015;2015:bcr2015209718. doi:10.1136/bcr-2015-209718. 28. 28- Moghadam, S. and Ghorbani, M. (2016) A Case of Megaloblastic Anemia with Thrombocytopenia. Open Journal of Obstetrics and Gynecology, 6, 534-538. doi: 10.4236/ojog.2016.69068.

[Housam Almadani, Ziyad T. Mirza and Banan Alsaied. (2017); CASE REPORT: PSUEDO-THROMBOTIC THROMBOCYTOPENIC PURPRA AND COBALAMINE DEFICIENCY. Int. J. of Adv. Res. 5 (Dec). 1523-1528] (ISSN 2320-5407). www.journalijar.com


Ziyad Mirza


DOI:


Article DOI: 10.21474/IJAR01/6115      
DOI URL: https://dx.doi.org/10.21474/IJAR01/6115