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Case 289 - Discussion

Hematopathology Case

Megaloblastic Anemia with Unusual Presentations Closely Mimicking Microangiopathic Hemolytic Anemia
  • The initial differential diagnosis of the peripheral blood findings included thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and other causes of microangiopathic hemolytic anemia;

  • The bone marrow biopsy showed a hypercellular marrow with predominant megaloblastic erythroid hyperplasia. Additional blood studies showed dramatically increased LDH 7330 u/L (normal 98-192 u/L) and methylmalonic acid level at 9.58 umol/L (normal 0.00-0.40umol/L) with decreased vitamin B12;

  • The patient received vitamin B12 treatment; After 3-4 days, he had a significant improvement of pancytopenia;

  • Therefore, the findings in our case indicate that MA has to be considered in the differential diagnosis of microangiopathic anemia, particular in patients with high risk for vitamin B12 deficiency (autoimmune disease, gastrointestinal surgery and dietary deficiency) and dramatic increase in serum lactate dehydrogenase

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