Thrombotic microangiopathy-like hemolysis in vitamin B12 deficiency-related megaloblastic macrocytic anemia

Yıl 2018, Cilt: 4 Sayı: 3, 145 - 148, 14.10.2018

Damla Çağla Patır Lütfiye Bilge Çalışkan Harun Akar

Öz

Vitamin B12 deficiency is common in Turkish population. Depending on the severity of B12 deficiency, patients may present with various clinical conditions and laboratory findings. B12 deficiency may manifest as thrombotic microangiopathy-like hemolysis. B12 deficiency presenting with thrombotic microangiopathy-like hemolysis may be called pseudothrombotic microangiopathy. Pseudothrombotic microangiopathy is anemia, thrombocytopenia, and schistocytosis caused by vitamin B12 deficiency. Pseudothrombotic microangiopathy may be mistakenly confused with microangiopathic hemolytic anemia, which can lead to confusion about the appropriate treatment approaches. Assessment of lactate dehydrogenase, reticulocyte count, bilirubin, and platelet counts may allow pseudothrombotic microangiopathy to be distinguished from a true microangiopathic hemolytic anemia. In this article, we report a case of pseudothrombotic microangiopathy due to severe vitamin B12 deficiency.

Anahtar Kelimeler

Hemolytic anemia, thrombocytopenia, Vitamin B12 deficiency

Kaynakça

• 1. Watkins D, Whitehead VM, Rosenblatt DS. Megaloblastic anemia. In: Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux SE, editors. Nathan and Oski’s Hematology of infancy and chilhood. Philadelphia: Saunders Elsevier; 2009. p. 467-520. 2. Green R. Folate, cobalamin, and megaloblastic anemias. In: Kaushansky K, Lichtman MA, Beutler E, Kipps TJ, Selighson U, Prchal JT, editors. Williams Hematology. 9th ed. Shanghai: The McGraw-Hill Companies; 2010. p. 533-64. 3. Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician 2003;67:979-86. 4. Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency--an update. Haematologica. 2006;91:1506-12. 5. Bor MV, Cetin M, Aytaç S, Altay C, Nexo E. Nonradioactive vitamin B12 absorption test evaluated in controls and in patients with inherited malabsorption of vitamin B12. Clin Chem 2005;51:2151-5. 6. Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular cobalamin treatment in megaloblastic anemia: a single-center, prospective, randomized, open-label study. Clin Ther 2003;25:3124-34. 7. Carmel R, Green R, Rosenblatt DS, Watkins D. Update on cobalamin, folate, and homocysteine. Hematology Am Soc Hematol Educ Program 2003:62-81. 8. Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood 2008;112:2214-21. 9. Hannibal L, Kim J, Brasch NE, Wang S, Rosenblatt DS, Banerjee R, et al. Processing of alkylcobalamins in mammalian cells: A role for the MMACHC (cblC) gene product. Mol Genet Metab 2009;97:260-6. 10. Antony AC. Megaloblastic anemias. In: Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, et al, editors. Hematology, Basic Principles and Practice. 4th ed. Philadelphia: Elsevier; 2005. p. 519-56. 11. Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G, et al. Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Haematol 2006;28:50-6. 12. Noël N, Maigné G, Tertian G, Anguel N, Monnet X, Michot JM, et al. Hemolysis and schistocytosis in the emergency department: consider pseudothrombotic microangiopathy related to vitamin B12 deficiency. QJM 2013;106:1017-22. 13. Veit K. Pseudothrombotic microangiopathy and vitamin B12 deficiency in pernicious anemia. Proc (Bayl Univ Med Cent) 2017;30:346-7.