Co-existence of Thrombotic Thrombocytopenic Purpura and Megaloblastic Anaemia: A Case-Based Review

Partisha Gupta; Sakir Ahmed; Nikunj Kishore Rout; Chaitanya Yelisetti; Ranjita Panigrahi; Pradip Kumar Behera; Krishna Padarabinda Tripathy; Sudhansu Sekhar Panda

doi:10.31138/mjr.33.2.241

Co-existence of Thrombotic Thrombocytopenic Purpura and Megaloblastic Anaemia: A Case-Based Review

Mediterr J Rheumatol. 2022 Jun 30;33(2):241-246. doi: 10.31138/mjr.33.2.241. eCollection 2022 Jun.

Authors

Partisha Gupta¹, Sakir Ahmed², Nikunj Kishore Rout³, Chaitanya Yelisetti¹, Ranjita Panigrahi⁴, Pradip Kumar Behera¹, Krishna Padarabinda Tripathy¹, Sudhansu Sekhar Panda¹

Affiliations

¹ Department of Internal Medicine, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
² Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
³ Department of Nephrology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
⁴ Department of Pathology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.

Abstract

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.

Keywords: TTP; megaloblastic anaemia; microangiopathic haemolytic anaemia; thrombocytopenia.