RESUMO
Microangiopathic haemolytic anaemia with thrombocytopenia, called pseudo-thrombotic microangiopathy (TMA), is a clinically important complication in patients with vitamin B12 deficiency. We herein present a case of an 80-year-old woman with pseudo-TMA after gastrectomy. She was initially suspected with thrombotic thrombocytopenic purpura based on rapid progression of anaemia with schistocytes and thrombocytopenia; however, her anaemia and thrombocytopenia were improved by vitamin B12 supplementation alone, with a single session of plasma exchange. Vitamin B12 deficiency was finally confirmed by low vitamin B12 levels from the patient's initial blood sample. In addition, normal ADAMTS13 activity was proven, lowering the likelihood of thrombotic thrombocytopenic purpura. Therefore, this patient was diagnosed with pseudo-TMA caused by vitamin B12 deficiency. Pseudo-TMA can occur in patients with vitamin B12 deficiency post-gastrectomy.
Assuntos
Anemia Hemolítica/diagnóstico , Gastrectomia/efeitos adversos , Microangiopatias Trombóticas/diagnóstico , Deficiência de Vitamina B 12/complicações , Proteína ADAMTS13/efeitos dos fármacos , Administração Intravenosa , Idoso de 80 Anos ou mais , Anemia Hemolítica/etiologia , Povo Asiático/etnologia , Diagnóstico Diferencial , Feminino , Humanos , Plasmaferese/métodos , Microangiopatias Trombóticas/etiologia , Resultado do Tratamento , Vitamina B 12/administração & dosagem , Vitamina B 12/uso terapêuticoRESUMO
Thrombocytopenia-associated multiple-organ failure (TAMOF) is an increasingly fatal phenomenon that may be associated with sepsis. TAMOF results from immune dysregulation and impaired activity of A Disintegrin And Metalloproteinase with ThromboSpondin type 1 motif, member 13. Early recognition of this premorbid condition and specific management results in a significantly improved outcome. Herein, we report the presentation and management of a 2-year-old child with TAMOF who was successfully treated with plasma exchange and recovered without long-term sequelae.