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Case Reports in Obstetrics and Gynecology
Volume 2019, Article ID 4325647, 4 pages
Case Report

Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome

1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
2Department of Obstetrics and Gynecology, Adventist Health White Memorial, Los Angeles, CA, USA
3Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
4Department of Medicine, Division of Nephrology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
5Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

Correspondence should be addressed to Richard M. Burwick; gro.shsc@kciwrub.drahcir

Received 29 November 2018; Accepted 18 March 2019; Published 25 March 2019

Academic Editor: Yossef Ezra

Copyright © 2019 Shravya Govindappagari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Severe vitamin B12 deficiency may present with hematologic abnormalities that mimic thrombotic microangiopathy disorders such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report a patient diagnosed with severe vitamin B12 deficiency, following termination of pregnancy for suspected preeclampsia and HELLP syndrome at 21 weeks’ gestation. When hemolysis and thrombocytopenia persisted after delivery, testing was performed to rule out other etiologies of thrombotic microangiopathy, including atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and vitamin B12 deficiency. This work-up revealed undetectable vitamin B12 levels and presence of intrinsic factor antibodies, consistent with pernicious anemia. Parenteral B12 supplementation was initiated, with subsequent improvement in hematologic parameters. Our case emphasizes the importance of screening for B12 deficiency in pregnancy, especially in at-risk women with unexplained anemia or thrombocytopenia. Moreover, providers should consider B12 deficiency and pernicious anemia in the differential diagnosis of pregnancy-associated thrombotic microangiopathy.