Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome
Severe vitamin B12 deficiency may present with hematologic abnormalities that mimic thrombotic microangiopathy disorders such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report a patient diagnosed with severe vitamin B12 deficiency, following termination of preg...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Obstetrics and Gynecology |
| Online Access: | http://dx.doi.org/10.1155/2019/4325647 |
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| author | Shravya Govindappagari Michelle Nguyen Megha Gupta Ramy M. Hanna Richard M. Burwick |
| author_facet | Shravya Govindappagari Michelle Nguyen Megha Gupta Ramy M. Hanna Richard M. Burwick |
| author_sort | Shravya Govindappagari |
| collection | DOAJ |
| description | Severe vitamin B12 deficiency may present with hematologic abnormalities that mimic thrombotic microangiopathy disorders such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report a patient diagnosed with severe vitamin B12 deficiency, following termination of pregnancy for suspected preeclampsia and HELLP syndrome at 21 weeks’ gestation. When hemolysis and thrombocytopenia persisted after delivery, testing was performed to rule out other etiologies of thrombotic microangiopathy, including atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and vitamin B12 deficiency. This work-up revealed undetectable vitamin B12 levels and presence of intrinsic factor antibodies, consistent with pernicious anemia. Parenteral B12 supplementation was initiated, with subsequent improvement in hematologic parameters. Our case emphasizes the importance of screening for B12 deficiency in pregnancy, especially in at-risk women with unexplained anemia or thrombocytopenia. Moreover, providers should consider B12 deficiency and pernicious anemia in the differential diagnosis of pregnancy-associated thrombotic microangiopathy. |
| format | Article |
| id | doaj-art-8ee22cbff12343799e69fe5613882bf5 |
| institution | Kabale University |
| issn | 2090-6684 2090-6692 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Obstetrics and Gynecology |
| spelling | doaj-art-8ee22cbff12343799e69fe5613882bf52025-02-03T01:27:27ZengWileyCase Reports in Obstetrics and Gynecology2090-66842090-66922019-01-01201910.1155/2019/43256474325647Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP SyndromeShravya Govindappagari0Michelle Nguyen1Megha Gupta2Ramy M. Hanna3Richard M. Burwick4Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USADepartment of Obstetrics and Gynecology, Adventist Health White Memorial, Los Angeles, CA, USADepartment of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USADepartment of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USADepartment of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USASevere vitamin B12 deficiency may present with hematologic abnormalities that mimic thrombotic microangiopathy disorders such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report a patient diagnosed with severe vitamin B12 deficiency, following termination of pregnancy for suspected preeclampsia and HELLP syndrome at 21 weeks’ gestation. When hemolysis and thrombocytopenia persisted after delivery, testing was performed to rule out other etiologies of thrombotic microangiopathy, including atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and vitamin B12 deficiency. This work-up revealed undetectable vitamin B12 levels and presence of intrinsic factor antibodies, consistent with pernicious anemia. Parenteral B12 supplementation was initiated, with subsequent improvement in hematologic parameters. Our case emphasizes the importance of screening for B12 deficiency in pregnancy, especially in at-risk women with unexplained anemia or thrombocytopenia. Moreover, providers should consider B12 deficiency and pernicious anemia in the differential diagnosis of pregnancy-associated thrombotic microangiopathy.http://dx.doi.org/10.1155/2019/4325647 |
| spellingShingle | Shravya Govindappagari Michelle Nguyen Megha Gupta Ramy M. Hanna Richard M. Burwick Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome Case Reports in Obstetrics and Gynecology |
| title | Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome |
| title_full | Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome |
| title_fullStr | Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome |
| title_full_unstemmed | Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome |
| title_short | Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome |
| title_sort | severe vitamin b12 deficiency in pregnancy mimicking hellp syndrome |
| url | http://dx.doi.org/10.1155/2019/4325647 |
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