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Peer-reviewedCC BYCureus

Combined Vitamin B12 and Folate Deficiency Presenting As Pseudo-Thrombotic Microangiopathy With a Disseminated Intravascular Coagulation (DIC)-Like Coagulation Profile: A Case Report

  • Moutaz W Sweileh1
  • Hisham Asaad2
  • Aya Abdi3
  1. 1Department of Biomedical Sciences and Basic Clinical Skills, An-Najah National University, Nablus, PSE
  2. 2Department of Internal Medicine, An-Najah National University, Nablus, PSE
  3. 3Department of Gynecology, Rafidia Surgical Hospital, Nablus, PSE
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Abstract

Severe vitamin B12 deficiency can rarely present as pseudo-thrombotic microangiopathy (pseudo-TMA), characterized by anemia, thrombocytopenia, biochemical hemolysis, and schistocytosis, thereby mimicking thrombotic thrombocytopenic purpura (TTP). Concomitant abnormalities of conventional coagulation parameters may further complicate the presentation by raising concern for disseminated intravascular coagulation (DIC). We report an unusual presentation of severe combined vitamin B12 and folate deficiency with pseudo-TMA and a DIC-like coagulation profile. A 56-year-old man with severe combined vitamin B12 and folate deficiency presented with profound pancytopenia, schistocytosis, biochemical hemolysis, inadequate reticulocytosis, and megaloblastic hematopoiesis despite normal mean corpuscular volume (MCV). Elevated D-dimer, prolonged prothrombin time (PT), and reduced fibrinogen produced a DIC-like profile. Hematologic and coagulation parameters improved within one week of starting vitamin B12 replacement; folic acid was initiated after that first week. Recognition of megaloblastic pseudo-TMA and its potential coagulation abnormalities may prevent misdiagnosis and unnecessary TTP-directed therapy.

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Cite

BibTeXRIS
BibTeX
@article{sweileh2026combined,
  title = {{Combined Vitamin B12 and Folate Deficiency Presenting As Pseudo-Thrombotic Microangiopathy With a Disseminated Intravascular Coagulation (DIC)-Like Coagulation Profile: A Case Report}},
  author = {Moutaz W Sweileh and Hisham Asaad and Aya Abdi},
  journal = {Cureus},
  year = {2026},
  month = sep,
  doi = {10.7759/cureus.117118},
  url = {https://europepmc.org/article/PMC/PMC13717260},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Combined Vitamin B12 and Folate Deficiency Presenting As Pseudo-Thrombotic Microangiopathy With a Disseminated Intravascular Coagulation (DIC)-Like Coagulation Profile: A Case Report
AU  - Moutaz W Sweileh
AU  - Hisham Asaad
AU  - Aya Abdi
PY  - 2026
DA  - 2026/09/28
JO  - Cureus
DO  - 10.7759/cureus.117118
UR  - https://europepmc.org/article/PMC/PMC13717260
AB  - Severe vitamin B12 deficiency can rarely present as pseudo-thrombotic microangiopathy (pseudo-TMA), characterized by anemia, thrombocytopenia, biochemical hemolysis, and schistocytosis, thereby mimicking thrombotic thrombocytopenic purpura (TTP). Concomitant abnormalities of conventional coagulation parameters may further complicate the presentation by raising concern for disseminated intravascular coagulation (DIC). We report an unusual presentation of severe combined vitamin B12 and folate deficiency with pseudo-TMA and a DIC-like coagulation profile. A 56-year-old man with severe combined vitamin B12 and folate deficiency presented with profound pancytopenia, schistocytosis, biochemical hemolysis, inadequate reticulocytosis, and megaloblastic hematopoiesis despite normal mean corpuscular volume (MCV). Elevated D-dimer, prolonged prothrombin time (PT), and reduced fibrinogen produced a DIC-like profile. Hematologic and coagulation parameters improved within one week of starting vitamin B12 replacement; folic acid was initiated after that first week. Recognition of megaloblastic pseudo-TMA and its potential coagulation abnormalities may prevent misdiagnosis and unnecessary TTP-directed therapy.
SN  - 2168-8184
ER  -