血栓性血小板减少性紫癜与巨幼细胞贫血并存：基于病例的综述
Co-existence of Thrombotic Thrombocytopenic Purpura and Megaloblastic Anaemia: A Case-Based Review.
作者信息
Gupta Partisha, Ahmed Sakir, Rout Nikunj Kishore, Yelisetti Chaitanya, Panigrahi Ranjita, Behera Pradip Kumar, Tripathy Krishna Padarabinda, Panda Sudhansu Sekhar
机构信息
Department of Internal Medicine, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
出版信息
Mediterr J Rheumatol. 2022 Jun 30;33(2):241-246. doi: 10.31138/mjr.33.2.241. eCollection 2022 Jun.
INTRODUCTION
Thrombotic thrombocytopenic purpura is a rare and fatal thrombotic microangiopathy characterised by a pentad of microangiopathic haemolytic anaemia, thrombocytopenia, renal abnormalities, neurological abnormalities, and fever. Due to ineffective erythropoiesis, vitamin-B12 deficiency may rarely present as haemolytic anaemia.
CASE REPORT
We report a case of a 42-year-old vegetarian female presenting as vitamin B12 deficiency anaemia found to have concomitant TTP, responding to plasmapheresis, corticosteroids, and rituximab therapy.
DISCUSSION
In this case of vitamin B12 deficiency with co-existent TTP, we hypothesise vitamin B12 deficiency as a contributory or precipitating factor for TTP. We reviewed similar cases in the literature to support this hypothesis. Timely detection of TTP and the initiation of treatment is of utmost importance as TTP has a high mortality when left untreated. The possible relationship with Vitamin B12 deficiency needs further exploration.
引言
血栓性血小板减少性紫癜是一种罕见且致命的血栓性微血管病，其特征为微血管病性溶血性贫血、血小板减少、肾脏异常、神经异常和发热五联征。由于红细胞生成无效，维生素B12缺乏症可能很少表现为溶血性贫血。
病例报告
我们报告一例42岁素食女性，表现为维生素B12缺乏性贫血，发现同时患有血栓性血小板减少性紫癜，对血浆置换、皮质类固醇和利妥昔单抗治疗有反应。
讨论
在这例维生素B12缺乏合并血栓性血小板减少性紫癜的病例中，我们推测维生素B12缺乏是血栓性血小板减少性紫癜的一个促成或诱发因素。我们回顾了文献中的类似病例以支持这一假设。及时检测血栓性血小板减少性紫癜并开始治疗至关重要，因为血栓性血小板减少性紫癜若不治疗死亡率很高。与维生素B12缺乏的可能关系需要进一步探索。
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