Congenital thrombotic thrombocytopenic purpura masquerading as vitamin B12 deficiency

Transfus Apher Sci. 2023 Oct;62(5):103728. doi: 10.1016/j.transci.2023.103728. Epub 2023 May 16.

Abstract

Introduction: Congenital thrombotic thrombocytopenic purpura (CTTP), also called Upshaw-Schulman syndrome (USS), is a rare autosomal recessive disorder resulting from the deficiency of the ADAMTS13. CTTP is characterized by the formation of platelet-rich thrombi in small vessels of multiple organs, resulting in thrombocytopenia and microangiopathic hemolytic anemia, eventually leading to organ failure.

Case report: We present a case of an 11-month-old male infant with CTTP lacking classic features of the disease. Instead, his clinical picture portrayed vitamin B12 deficiency, leading to misdiagnosis and subsequent treatment delay.

Conclusion: This case led to the conclusion that congenital TTP should be suspected in case of vitamin B12 deficiency if the child does not respond to the vitamin B12 replacement therapy. We also emphasize that management for CTTP should be started at its earliest in case of increased clinical suspicion to avoid worse outcomes, especially in countries lacking rapid availability of enzyme assay.

Keywords: Hemolytic anemia; Thrombotic thrombocytopenic purpura; Upshaw Schulman syndrome; Vitamin B12 deficiency.

Publication types

  • Case Reports

MeSH terms

  • ADAMTS13 Protein
  • Anemia, Hemolytic*
  • Humans
  • Infant
  • Male
  • Purpura, Thrombotic Thrombocytopenic* / diagnosis
  • Purpura, Thrombotic Thrombocytopenic* / therapy
  • Vitamin B 12
  • Vitamin B 12 Deficiency* / diagnosis

Substances

  • ADAMTS13 Protein
  • Vitamin B 12