Pseudo-thrombotic microangiopathy due to folate deficiency

BMJ Case Rep. 2023 Jan 20;16(1):e251473. doi: 10.1136/bcr-2022-251473.

Abstract

Classically, deficiencies of vitamin B12 and folate are associated with megaloblastic anaemia. Additionally, vitamin B12 is able to cause a haemolytic anaemia in the form of pseudo-thrombotic microangiopathy (pseudo-TMA). Here, we present a case of a middle-aged woman with a history of Roux-en-Y gastric bypass who presented with dyspnoea and fatigue and was found to have thrombocytopenia and a non-immune haemolytic anaemia. Work-up for haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, paroxysmal nocturnal haemoglobinuria, infection, malignancy and autoimmune conditions was unremarkable. Her haemolytic anaemia and thrombocytopenia resolved with folate replenishment. She was diagnosed as likely having pseudo-TMA secondary to folate deficiency.

Keywords: Malignant and Benign haematology; Malnutrition.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Hemolytic* / complications
  • Female
  • Folic Acid / therapeutic use
  • Folic Acid Deficiency* / complications
  • Folic Acid Deficiency* / diagnosis
  • Humans
  • Middle Aged
  • Purpura, Thrombotic Thrombocytopenic* / diagnosis
  • Thrombotic Microangiopathies* / complications
  • Thrombotic Microangiopathies* / etiology
  • Vitamin B 12
  • Vitamins

Substances

  • Vitamin B 12
  • Folic Acid
  • Vitamins