SHM Converge Scientific Abstract ePoster Gallery-When Destruction Masks Deficiency: Pernicious Anemia Presenting as Hemolysis

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This case report describes a 44-year-old man with hypertension who presented with months of progressive weakness and dizziness. Although his physical exam was unremarkable, initial labs showed severe pancytopenia and strong evidence of hemolysis, including very high LDH and undetectable haptoglobin, raising concern for thrombotic thrombocytopenic purpura (TTP) and prompting transfusion and hematology consultation.<br /><br />Further evaluation revealed the true cause: severe vitamin B12 deficiency due to pernicious anemia. Confirmatory testing showed low B12, markedly elevated homocysteine and methylmalonic acid, hypersegmented neutrophils on peripheral smear, and a positive intrinsic factor blocking antibody. Folate was normal.<br /><br />The report emphasizes that pernicious anemia can occasionally present with pseudo-TTP, a syndrome that mimics true TTP but is caused by ineffective erythropoiesis and intramedullary hemolysis rather than ADAMTS13 deficiency and microthrombi. Pseudo-TTP occurs in a minority of B12-deficient patients and can lead to unnecessary and risky plasma exchange if misdiagnosed.<br /><br />After treatment with monthly cobalamin injections, the patient’s hemoglobin, LDH, and haptoglobin normalized. The case highlights the importance of considering vitamin B12 deficiency in patients with hemolytic anemia, pancytopenia, and macrocytosis, especially when neurologic symptoms, autoimmune disease, or other risk factors are present. Early diagnosis matters because neurologic complications of B12 deficiency may become irreversible if treatment is delayed.

Asset Subtitle

Kavya Yellamraju

Meta Tag

Author List Kavya Yellamraju, Michael Hardman

Category Clinical Vignettes

Concept Vitamin B12 Deficiency

Concept Pernicious Anemia

Concept Pancytopenia

Concept Pseudo-thrombotic Thrombocytopenic Purpura

Concept Vitamin B12 Replacement

Distinguished Non-Finalist

Presenter Organization Ohio Health Riverside Methodist Hospital

Presenting Author Kavya Yellamraju

Track Adult

Keywords

pernicious anemia

vitamin B12 deficiency

pseudo-TTP

thrombotic thrombocytopenic purpura

pancytopenia

hemolysis

intrinsic factor antibody

macrocytosis

hypersegmented neutrophils

cobalamin injections

Vitamin B12 Deficiency

Pernicious Anemia

Pancytopenia

Pseudo-thrombotic Thrombocytopenic Purpura

Vitamin B12 Replacement