Combined Vitamin B12 and Folate Deficiency Presenting As Pseudo-Thrombotic Microangiopathy With a Disseminated Intravascular Coagulation (DIC)-Like Coagulation Profile: A Case Report
Year: 2026
Type: article
Study design: Case Report
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.
Source: Cureus
Authors: Moutaz W Sweileh, Hisham Asaad, Aya Abdi
Institution: An-Najah National University
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214798345