Osman Haitham, Alwasaidi Turki A, Al-Hebshi Abdulqader, Almutairi Najah, Eltabbakh Hussein
Hematology, Prince Mohammed Bin Abdulaziz Hospital/Ministry of National Guard Health Affairs, Madinah, SAU.
Internal Medicine, Taibah University, Madinah, SAU.
Cureus. 2021 Jan 10;13(1):e12600. doi: 10.7759/cureus.12600.
Vitamin B12 has essential roles in DNA synthesis, red blood cell development, and neurologic functions. Vitamin B12 deficiency is relatively common, particularly in people aged over 60 years. Among hematological disturbances, microangiopathic hemolytic anemia with thrombocytopenia or so-called pseudo-thrombotic microangiopathy (pseudo-TMA) is a particularly rare but significant clinical complication in patients with vitamin B12 deficiency. We herein describe a case of an elderly patient with pseudo-TMA whose lack of vitamin B12 was misdiagnosed as thrombotic thrombocytopenic purpura (TTP). The patient was admitted as a case of pancytopenia with a hemolytic picture. The initial impression was TTP versus acute promyelocytic leukemia M3. After examination of laboratory tests and bone marrow examination, we deduced that the patient had a B12 deficiency. The condition of the patient improved with B12 replacement. This report should remind physicians to widen their differential diagnoses when patients present with microangiopathic hemolysis or in patients who are not responsive to standard treatments for TTP.
维生素B12在DNA合成、红细胞发育和神经功能中起着至关重要的作用。维生素B12缺乏相对常见，尤其是在60岁以上的人群中。在血液系统紊乱中，伴有血小板减少的微血管病性溶血性贫血或所谓的假性血栓性微血管病（假性TMA）是维生素B12缺乏患者中一种特别罕见但重要的临床并发症。我们在此描述一例老年假性TMA患者，其维生素B12缺乏被误诊为血栓性血小板减少性紫癜（TTP）。该患者因全血细胞减少伴溶血表现入院。初步印象是TTP与急性早幼粒细胞白血病M3。经过实验室检查和骨髓检查，我们推断该患者存在维生素B12缺乏。补充维生素B12后患者病情好转。本报告应提醒医生，当患者出现微血管病性溶血或对TTP的标准治疗无反应时，应拓宽鉴别诊断范围。
