Advertisement

The Indian Journal of Pediatrics

, Volume 85, Issue 4, pp 322–324 | Cite as

Microangiopathic Hemolytic Anemia – A Rare Presentation of Vitamin B12 Deficiency

  • K. Jagadish Kumar
  • Divya Chowdary
  • Akshatha U. Shetty
  • C. Anitha
Scientific Letter
To the Editor: A 14-y-old vegetarian boy presented with tiredness since one week. On examination he was pale, icteric, palms were hyperpigmented and had splenomegaly. Investigations are shown in the Table  1. In view of low vitamin B 12 levels, intramuscular hydroxycobalamin 1000 microgram was given for 2 d followed by tablet mecobalamin 500 mg twice a day. During the follow-up, hemoglobin started increasing without any further hemolysis.
Table 1

Investigations in the present child

Parameters

At admission

3rd day of admission

5th day after mecobalmin

20 d of mecobalamin

4 mo of mecobalamin

HB (g/dl)

6.1

10.9

10.7

13.9

14.9

PCV %

17.8

33.9

   

44.8

RBC Count (million/mm3)

1.73

     

6.15

MCV (fl)

102.9

     

72.8

MCH (pg)

35.3

     

24.2

MCHC (g/dl)

34.3

     

33.3

RDW%

23.0

     

15

Reticulocyte count %

7.0

 

3

1.4

0.8

TLC cells/mm3

5340

 

5800

8220

7200

DLC [N,L,E,M,B] %

39.5, 53.9, 1.5, 4.9, 0.2

     

67,26,2,4,0.3

Platelet Count (Lakhs/mm3)

1.85

1.51

4.63

3.02

3.34

ESR mm 1st hour

20

Notes

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    Dhaliwal G, Cornett PA, Tierney LM Jr. Hemolytic anemia. Am Fam Physician. 2004;69:2599–606.PubMedGoogle Scholar
  2. 2.
    Tuten N, Bennett C, Babcock W. Thrombotic thrombocytopenic purpura or cobalamin deficiency? A case report and review. Clin Case Rep Rev. 2015;1:157–9.CrossRefGoogle Scholar
  3. 3.
    Andrès E, Affenberger S, Zimmer J, 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Mishra VA, Harbada R, Sharma A. Vitamin B12 and vitamin D deficiencies: an unusual cause of fever, severe hemolyticanemia and thrombocytopenia. J Family Med Prim Care. 2015;4:145–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Noel N, Maigné G, Tertian G, et al. Hemolysis and schistocytosis in the emergency department: consider pseudothrombotic microangiopathy related to vitamin B12 deficiency. QJM. 2013;106:1017–22.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  • K. Jagadish Kumar
    • 1
  • Divya Chowdary
    • 1
  • Akshatha U. Shetty
    • 1
  • C. Anitha
    • 1
  1. 1.Department of PediatricsJSS Medical College, JSS UniversityMysoreIndia

Personalised recommendations