Pancytopenia and TTP-like picture secondary to pernicious anaemia. Issue 7 (5th July 2020)

• Record Type: Journal Article
• Authors: Chen, Peiting; Ramachandran, Preethi; Josan, Karan; Wang, Jen Chin
• Is Part Of: BMJ case reports. Volume 13:Issue 7(2020)
• Publication Date: 2020-07-05
• Subjects: nutrition -- haematology (incl blood transfusion); Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-235288
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 21-year-old man presented to the emergency department with generalised weakness, weight loss and decreased appetite for few weeks. He had evidence of severe pancytopenia and haemolysis. His peripheral smear with many schistocytes was suspicious for thrombotic thrombocytopenic purpura (TTP). He was supported with blood transfusions and daily plasmapheresis. His platelet counts worsened despite 4 days of therapy. Bone marrow biopsy was significant for hypercellular bone marrow with megaloblastic changes. Further workup revealed normal ADAMTS13 level, low vitamin B12, positive intrinsic factor antibodies and high methylmalonic acid. Diagnosis of pernicious anaemia was established and he was started on daily treatment with intramuscular vitamin B12 which subsequently improved his symptoms and haematological parameters. This report highlights the importance of checking vitamin B12 level in patients presenting with pancytopenia and TTP-like picture before making a diagnosis of TTP.