Vitamin B12 Deficiency and Hemoglobin H Disease Early Misdiagnosed as Thrombotic Thrombocytopenic Purpura: A Series of Unfortunate Events
Table 1
Patient’s blood results: (1) during admission, (2) after the transfusion of 4 packed RBCs units, (3) after the CVC insertion, hemothorax and intubation, (4) at discharge after having received therapy for B12 deficiency, (5) and finally during reevaluation as an outpatient.
(1) Admission
(2) After transfusion
(3) After CVC placement
(4) Discharge
(5) Reevaluation
Hematocrit (%)
10.8
23.17
18.8
28.8
35.2
Hemoglobin (gr/dL)
3.1
7.99
6.36
9.2
10.9
Red Blood Cells (106/μL)
1.3
2.74
2.29
3.54
5.06
Mean Corpuscular Volume (MCV) (fL)
84.5
82.31
85.1
81.3
69.6
Mean corpuscular hemoglobin (MCH) (pg)
29.1
28.24
29.3
25.9
21.5
Mean corpuscular hemoglobin concentration (MCHC) (g/dL)
33.1
34.3
33.8
31.9
30.9
Reticulocytes (%)
0.1
3
White blood cells (103/μL)
8.50
3.9
9.5
6.34
10.81
Neutrophils (%)
90.2
95.4
95.4
61
66
Lymphocytes (%)
8.4
3.8
3.8
16.9
24.8
Monocytes (%)
0.6
0.6
0.6
8.4
5.6
Eosinophils (%)
0.1
0.06
0.06
12.9
3.7
Platelets (103/μL)
130
55
25
359
252
Prothrombin time, PT (Sec)
12.9
12.9
15
13.2
11.2
International Normalized Ratio (INR)
1.12
1.14
1.33
1.17
0.99
Activated partial thromboplastin time (APTT) (sec)
