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Microangiopathic thrombocytopenia caused by vitamin B12 deficiency responding to plasma exchange

Denis M Dwyre1, Jyotsna Reddy2, Leonor P Fernando1

  • 1Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California, USA.

British Journal of Haematology
|July 20, 2024
PubMed

A young adult African American female presented with normocytic microangiopathic haemolytic anaemia, elevated lactate dehydrogenase and thrombocytopenia. The patient responded to therapeutic plasma exchanges (TPE) for presumed thrombotic microangiopathy caused by thrombotic thrombocytopenic purpura (TTP). After relapsing, the patient was found to have pancytopenia, megaloblastic bone marrow and low vitamin B12 consistent with pernicious anaemia, which improved with intramuscular B12 and discontinuation of TPE. B12-deficient macrocytosis was not seen at presentation due to concomitant alpha-thalassaemia. Initial clinical/laboratory improvement is attributed to B12 present in TPE plasma. B12 deficiency can mimic TTP. Vigilance is needed regarding atypical presentations of pernicious anaemia.

Keywords:
haemolytic anaemiamegaloblastic cytopeniaplasma exchangethrombotic microangiopathythrombotic thrombocytopenic purpuravitamin B12 deficiency

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