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10.4103/2229-5151.183026 http://scihub22266oqcxt.onion/10.4103/2229-5151.183026 C4901834!4901834 !27308258     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27308258 &cmd=llinks): Failed to open stream: HTTP request failed! 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When the picture is fragmented: Vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura |pdf=|usr=}}{{27308258 }} gab.com Text When the picture is fragmented: Vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura JO: Int J Crit Illn Inj Sci http://www.kidney.de/pget.php?&tw=1&pmid=27308258 #FOAvip Thrombotic thrombocytopenic purpura (TTP) has high mortality and necessitates prompt recognition of microangiopathic hemolytic anemia (MAHA) and initiation of plasmapheresis. We present a challenging diagnostic workup and management of a 42-year-old man who presented with anemia, thrombocytopenia, and schistocytes on peripheral smear, all pointing to MAHA. Plasmapheresis and steroid therapy were promptly initiated, but hemolysis continued. Further workup showed megaloblastic anemia, severe Vitamin B12 deficiency, high iron saturation, and absent reticulocytosis, none of which could be explained by TTP. Severe Vitamin B12 deficiency can lead to hemolytic anemia from the destruction of red cells in the marrow that have failed the process of maturation. However, this should not cause thrombotic microangiopathy. Previous reports of B12 deficiency presenting with MAHA and a TTP-like manifestation have identified acute hyperhomocysteinemia as a missing link between B12 deficiency and MAHA, so this possibility was further explored. Our patient similarly had significantly elevated serum homocysteine levels, confirming this suspicion of Vitamin B12 deficiency. Vitamin B12 replacement led to normalization of the elevated levels of homocysteine, the disappearance of schistocytes on the peripheral smear, and resolution of the microangiopathic hemolysis, thereby confirming the diagnosis. It is pertinent that intensivists not only know the importance of early recognition and treatment of TTP but are also familiar with rare conditions that can present in a similar fashion. Twit Text FOAVip When the picture is fragmented: Vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura ????Int J Crit Illn Inj Sci http://www.kidney.de/pget.php?&tw=1&pmid=27308258 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27308258 #FOAvip English Wikipedia <ref>{{Cite pmid|27308258 }}</ref> When the picture is fragmented: Vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura #MMPMID27308258 Panchabhai TS ; Patil PD ; Riley EC ; Mitchell CK Int J Crit Illn Inj Sci 2016[Apr]; 6 (2 ): 89-92 PMID27308258 show ga Thrombotic thrombocytopenic purpura (TTP) has high mortality and necessitates prompt recognition of microangiopathic hemolytic anemia (MAHA) and initiation of plasmapheresis. We present a challenging diagnostic workup and management of a 42-year-old man who presented with anemia, thrombocytopenia, and schistocytes on peripheral smear, all pointing to MAHA. Plasmapheresis and steroid therapy were promptly initiated, but hemolysis continued. Further workup showed megaloblastic anemia, severe Vitamin B12 deficiency, high iron saturation, and absent reticulocytosis, none of which could be explained by TTP. Severe Vitamin B12 deficiency can lead to hemolytic anemia from the destruction of red cells in the marrow that have failed the process of maturation. However, this should not cause thrombotic microangiopathy. Previous reports of B12 deficiency presenting with MAHA and a TTP-like manifestation have identified acute hyperhomocysteinemia as a missing link between B12 deficiency and MAHA, so this possibility was further explored. Our patient similarly had significantly elevated serum homocysteine levels, confirming this suspicion of Vitamin B12 deficiency. Vitamin B12 replacement led to normalization of the elevated levels of homocysteine, the disappearance of schistocytes on the peripheral smear, and resolution of the microangiopathic hemolysis, thereby confirming the diagnosis. It is pertinent that intensivists not only know the importance of early recognition and treatment of TTP but are also familiar with rare conditions that can present in a similar fashion. äWhen the picture is fragmented: Vitamin B12 deficiency masquerading as(epmc).pdf DeepDyve Pubget Overpricing