Hémolyse et schizocytose, malabsorption et «piège à folates»: à propos de particularités sémiologiques mal connues des carences en vitamine B12

Jubault, V.; Lacroix-Szmania, I de; Zittoun, J; Jouault, Hélène; Lesprit, Philippe; Godeau, B.; Schaeffer, A

doi:10.1016/s0248-8663(99)80066-6

Cited by 15 publications

(6 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A majority of the present patients underwent bone marrow aspiration and complete assessment to rule out other explanations of these hematological abnormalities. In recent years, it is of note that several such patients with life‐threatening hematological manifestations related to cobalamin deficiency have been misdiagnozed and treated with aggressive therapies including steroids, polyvalent immunoglobulins and plasmapheresis (Jubault et al. , 1998; Blanc et al.…”

Section: Discussionmentioning

confidence: 99%

Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency

et al. 2006

View full text Add to dashboard Cite

With the introduction of automated assays for measuring serum cobalamin levels over the last decades, the hematological manifestations related to cobalamin deficiency have been changed from the description reported in 'old' studies or textbooks. We studied the hematological manifestations or abnormalities in 201 patients (median age: 67 +/- 6 years) with well-documented cobalamin deficiency (mean serum vitamin B12 levels 125 +/- 47 pg/ml) extracted from an observational cohort study (1995-2003). Assessment included clinical features, blood count and morphological review. Hematological abnormalities were reported in at least two-third of the patients: anemia (37%), leukopenia (13.9%), thrombopenia (9.9%), macrocytosis (54%) and hypegmented neutrophils (32%). The mean hemoglobin level was 10.3 +/- 0.4 g/dl and the mean erythrocyte cell volume 98.9 +/- 25.6 fl. Approximately 10% of the patients have life-threatening hematological manifestations with documented symptomatic pancytopenia (5%), 'pseudo' thrombotic microangiopathy (Moschkowitz; 2.5%), severe anemia (defined as Hb levels <6 g/dl; 2.5%) and hemolytic anemia (1.5%). Correction of the hematological abnormalities was achieved in at least two-thirds of the patients, equally well in patients treated with either intramuscular or oral crystalline cyanocobalamin. This study, based on real data from a single institution with a large number of consecutive patients with well-documented cobalamin deficiency, confirms several 'older' findings that were previously reported before the 1990s in several studies and in textbooks.

show abstract

Section: Discussionmentioning

confidence: 99%

Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Schistocytes are fragmented parts of red blood cells due to the circulation of blood through damaged capillaries and loss of endothelial system homeostasis. They are pathognomonic features of microangiopathic hemolytic anemia which is seen in thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), bone metastatic cancers [ 2 ], and drug mediated thrombotic microangiopathy.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Presentation of Pseudothrombotic Microangiopathy in a Patient with Autoimmune Atrophic Gastritis

Malek

Nasnas

2016

Case Reports in Hematology

View full text Add to dashboard Cite

Introduction. We hereby describe the case of a young female patient who presented with pseudothrombotic microangiopathy, as well as pancytopenia accompanied by autoimmune atrophic gastritis. Case Presentation. A 36-year-old Caucasian woman presented to the emergency department with fatigue and dyspnea on minimal exertion. Physical examination was unremarkable except for pallor and noninjected conjunctiva. Laboratory tests revealed high LDH and low hemoglobin, white blood cells, platelets, and haptoglobin. The peripheral blood smear showed schistocytes suggestive of pseudothrombotic microangiopathy. Low cobalamin level and hyperhomocysteinemia were also detected. Autoimmune atrophic gastritis was confirmed by gastric biopsy and positive anti-intrinsic factor antibodies. Vitamin B12 supplements were given which led to rapid recovery and normalization of blood parameters. Conclusion. This case highlights the importance and serves as a reminder to clinicians to rule out cobalamin deficiency and autoimmune atrophic gastritis in patients presenting with a picture suggestive of thrombotic thrombocytopenic purpura and pancytopenia, which was completely reversible after appropriate replacement therapy without recurring to unnecessary and invasive procedures such as plasma exchange.

show abstract

“…Given the emergence of multiple case reports of cobalamin deficiency induced TMA, we strongly recommend the addition of cobalamin and methylmalonic acid testing to the diagnostic panel. Aggressive interventions [ 86 , 91 ] such as TPE, Rituximab, and steroids may be avoided by increasing physician awareness regarding cobalamin deficiency induced TMA and routine screening for cobalamin deficiency. Furthermore, empirical oral cobalamin supplementation in TTP suspected cases may be considered in light of the limited specificity of screening for cobalamin deficiency and the lack of evidence of cobalamin toxicity.…”

Section: Discussionmentioning

confidence: 99%

Pernicious Anemia Associated Cobalamin Deficiency and Thrombotic Microangiopathy: Case Report and Review of the Literature

Yousaf

Spinowitz

Charytan

et al. 2017

Case Reports in Medicine

View full text Add to dashboard Cite

A 43-year-old Hispanic male without significant previous medical history was brought to emergency department for syncope following a blood draw to investigate a 40 lbs weight loss during the past 6 months associated with decreased appetite and progressive fatigue. The patient also reported a 1-month history of jaundice. On examination, he was hemodynamically stable and afebrile with pallor and diffuse jaundice but without skin rash or palpable purpura. Normal sensations and power in all extremities were evident on neurological exam. Presence of hemolytic anemia, schistocytosis, thrombocytopenia, and elevated lactate dehydrogenase (LDH) was suggestive of thrombotic thrombocytopenic purpura (TTP). However, presence of leukopenia, macrocytes, and an inadequate reticulocyte response to the degree of anemia served as initial clues to an alternative diagnosis. Two and one units of packed red blood cells were transfused on day 1 and day 3, respectively. In addition, one unit of platelets was transfused on day 2. Daily therapeutic plasma exchange (TPE) was initiated and continued until ADAMTS-13 result ruled out TTP. A low cobalamin (vitamin B12) level was evident at initial laboratory work-up and subsequent testing revealed positive intrinsic factor-blocking antibodies supporting a diagnosis of pernicious anemia with severe cobalamin deficiency. Hematological improvement was observed following vitamin B12 supplementation. The patient was discharged and markedly improved on day 9 with outpatient follow-up for cobalamin supplementation.

show abstract

Hémolyse et schizocytose, malabsorption et «piège à folates»: à propos de particularités sémiologiques mal connues des carences en vitamine B12

Cited by 15 publications

References 4 publications

Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency

Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency

An Unusual Presentation of Pseudothrombotic Microangiopathy in a Patient with Autoimmune Atrophic Gastritis

Pernicious Anemia Associated Cobalamin Deficiency and Thrombotic Microangiopathy: Case Report and Review of the Literature

Contact Info

Product

Resources

About