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

Adult Vitamin B12 Deficiency-Associated Pseudo-Thrombotic Microangiopathy: A Systematic Review of Case Reports

“…Instead, we propose a modified PLASMIC score incorporating the reticulocyte index into the calculation to overcome this shortcoming. In a previous systematic review by Tran et al, the maximum reticulocyte production index (RPI) in the cases reviewed was 1.57% [5], and, in our review, the maximum reported value was 2.7% (Gupta et al), where the patient also had concomitant TTP [25]. Usually, >3% RPI is considered a normal response to anemia [5].…”

“…Fifteen patients (32.6%) also received plasma exchange (PLEX). The patients reported by Ricci et al and Gupta et al also had concomitant TTP and received rituximab [ 25 , 45 ]. Eight patients received steroids, one patient received eculizumab [ 40 ], and one patient received caplacizumab [ 12 ].…”

“…In our review, we discovered that 15 patients received plasmapheresis, of whom five patients received concomitant systemic steroids. ADAMTS13 level was normal in all but two patients where TTP co-existed with vitamin B12 deficiency [ 25 , 45 ]. Based on these findings, it appears that the PLASMIC score cannot be used to distinguish between these two disorders reliably.…”