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Further workup revealed normal ADAMTS13 level, low vitamin B<jats:sub>12<\/jats:sub>, positive intrinsic factor antibodies and high methylmalonic acid. Diagnosis of pernicious anaemia was established and he was started on daily treatment with intramuscular vitamin B<jats:sub>12<\/jats:sub> which subsequently improved his symptoms and haematological parameters. This report highlights the importance of checking vitamin B<jats:sub>12<\/jats:sub> level in patients presenting with pancytopenia and TTP-like picture before making a diagnosis of TTP.<\/jats:p>","DOI":"10.1136\/bcr-2020-235288","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T02:02:30Z","timestamp":1594000950000},"page":"e235288","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Pancytopenia and TTP-like picture secondary to pernicious anaemia"],"prefix":"10.1136","volume":"13","author":[{"given":"Peiting","family":"Chen","sequence":"first","affiliation":[{"name":"Hematology\/Oncology, Brookdale University Hospital Medical Center, Brooklyn, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3032-8886","authenticated-orcid":false,"given":"Preethi","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, Brookdale University Hospital Medical Center, Brooklyn, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karan","family":"Josan","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, Brookdale University Hospital Medical Center, Brooklyn, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9623-6645","authenticated-orcid":false,"given":"Jen Chin","family":"Wang","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, Brookdale University Hospital Medical Center, Brooklyn, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"key":"2025082708233655000_13.7.e235288.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2257.2006.00755.x"},{"key":"2025082708233655000_13.7.e235288.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1113996"},{"key":"2025082708233655000_13.7.e235288.3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.transci.2018.01.003","article-title":"Cobalamin deficiency presenting with thrombotic microangiopathy (TMA) features: a systematic review","volume":"57","author":"Tran","year":"2018","journal-title":"Transfus Apher Sci"},{"key":"2025082708233655000_13.7.e235288.4","first-page":"23","article-title":"Genomic imbalances in peripheral blood confirm the diagnosis of myelodysplastic syndrome in a patient presenting with non-immune hemolytic anemia","volume":"5","author":"Zahid","year":"2016","journal-title":"Leuk Res Rep"},{"key":"2025082708233655000_13.7.e235288.5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/jca.21316","article-title":"Cocaine-Induced microangiopathic hemolytic anemia mimicking idiopathic thrombotic thrombocytopenic purpura: a case report and review of the literature","volume":"29","author":"Odronic","year":"2014","journal-title":"J Clin Apher"},{"key":"2025082708233655000_13.7.e235288.6","first-page":"1381","article-title":"Agranulocytosis associated with cocaine use - 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