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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Bibliographic Details
Published in:Case reports in obstetrics and gynecology 2019, Vol.2019 (2019), p.1-4
Main Authors: Hanna, Ramy Magdy, Gupta, Megha, Nguyen, Michelle, Govindappagari, Shravya, Burwick, Richard M.
Format: Article
Language:English
Subjects:
Anemia
Antibodies
Blood platelets
Blood pressure
Case Report
Case reports
Dehydrogenases
Development and progression
Enzymes
Gastrointestinal surgery
Health aspects
Hemoglobin
Hypertension
Laboratories
Methamphetamine
Preeclampsia
Pregnancy
Pregnant women
Premature birth
Systematic review
Telmisartan
Urine
Viral antibodies
Vitamin B12 deficiency
Vitamin deficiency
Vitamins
Womens health
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Summary: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.
ISSN:2090-6684
2090-6692
DOI:10.1155/2019/4325647