Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome

Table 1

Laboratory or treatment measures before and after delivery.

Laboratory or Treatment Measure	Initial evaluation	Prior to delivery	PPD 1	PPD 2	PPD 3	PPD4	PPD5
	21+4/7 weeks gestation	21+5/7 weeks gestation
Hemoglobin (g/dl)	11.0	9.7	8.4	9.0	9.5	8.8	9.3
Platelet Count (k/μl)	66	93	90	103	133	112	175
Lactate dehydrogenase (U/L)	985	872	706	n/a	n/a	n/a	404
Alanine transaminase (U/L)	20	14	24	12	12	13	15
Aspartate transaminase (U/L)	40	30	20	19	15	19	19
Creatinine (mg/dl)	0.7	0.9	0.9	0.6	0.8	0.8	0.8
Haptoglobin (mg/dl)	<8	n/a	<8	<8	n/a	n/a	n/a
Vitamin B12 (ρg/ml)	n/a	n/a	<146	n/a	n/a	n/a	n/a
Vitamin B12 supplementation (subcutaneous injection)	n/a	n/a	1000 mcg	1000 mcg	1000 mcg	1000 mcg	1000 mcg

PPD: postpartum day; n/a: not available.
Normal ranges: Hemoglobin (11.6-15.4 g/dl); Platelet count (150-450 k/μl); Lactate dehydrogenase (125-220); Alanine transaminase (0-55 U/L); Aspartate transaminase (5-34 U/L); Creatinine (0.6-1.1 mg/dl); Haptoglobin (30-200 mg/dl); Vitamin B12 (213-816 ρg/ml).