{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:36:11Z","timestamp":1786977371188,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Vitamin B12 deficiency is a common cause of normocytic or megaloblastic anemia. In 2.5% of cases, it can manifest as pseudo\u2010thrombotic microangiopathy (pseudo\u2010TMA), which mimics thrombotic thrombocytopenic purpura (TTP), an emergent hemolytic microangiopathy. This case report discusses a stable\u2010appearing 45\u2010year\u2010old female with progressive fatigue, heavy menstrual bleeding, bleeding gums, and easy bruising. Laboratory testing demonstrated low vitamin B12 (121\u2009pg\/mL), pancytopenia, exaggeratedly elevated LDH, undetectable haptoglobin, low reticulocyte production index (RPI), and positive intrinsic factor antibody. She was diagnosed with pseudo\u2010TMA. Unlike TTP, pseudo\u2010TMA patients often appear clinically well and hemodynamically stable without renal or neurologic dysfunction. Other key differentiators of pseudo\u2010TMA include progressive anemia, often with irregular red cell morphology; evidence of pancytopenia, neutropenia, and reticulocytopenia; and LDH levels exceeding 2500\u2009units\/L. While clinicians should maintain a low threshold for recognizing TTP as a hematologic emergency, they must also maintain awareness of pseudo\u2010TMA to prevent misdiagnosis and unnecessary plasmapheresis and to optimize treatment.<\/jats:p>","DOI":"10.1002\/ccr3.72551","type":"journal-article","created":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T02:30:01Z","timestamp":1776565801000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vitamin\n                    <scp>B12<\/scp>\n                    Deficiency\u2010Associated Pseudo\u2010Thrombotic Microangiopathy in a Patient on Longstanding Oral\n                    <scp>B12<\/scp>\n                    Supplementation"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6017-051X","authenticated-orcid":false,"given":"Hanna K.","family":"Bertucci","sequence":"first","affiliation":[{"name":"Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8726-7132","authenticated-orcid":false,"given":"Benjamin M.","family":"Moy","sequence":"additional","affiliation":[{"name":"Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Stein","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5226"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.013441"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1304350"},{"key":"e_1_2_12_5_1","volume-title":"Hematology: Basic Principles and Practice","author":"Hoffman R.","year":"2018"},{"issue":"3","key":"e_1_2_12_6_1","first-page":"294","article-title":"Vitamin B12 Deficiency: Common Questions and Answers","volume":"112","author":"Patel H.","year":"2025","journal-title":"American Family Physician"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/bs.vh.2022.02.003"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102257.2006.00755.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/bs.vh.2022.01.002"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2018.01.003"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmad065"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm\u20102014\u20100843"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm\u20102025\u20100939"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm\u20102013\u20100738"},{"issue":"6","key":"e_1_2_12_15_1","first-page":"384","article-title":"Vitamin B12 Deficiency: Recognition and Management","volume":"96","author":"Langan R. C.","year":"2017","journal-title":"American Family Physician"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72551","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72551","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72551","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:45:17Z","timestamp":1781253917000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/ccr3.72551"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72551","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72551"}}