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Pseudo-thrombotic microangiopathy due to folate deficiency
  1. Emily Larkin1,
  2. Samuel Konkol2 and
  3. Meghan Geraghty2
  1. 1Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  2. 2Internal Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Emily Larkin; ejl6ny{at}


Classically, deficiencies of vitamin B12 and folate are associated with megaloblastic anaemia. Additionally, vitamin B12 is able to cause a haemolytic anaemia in the form of pseudo-thrombotic microangiopathy (pseudo-TMA). Here, we present a case of a middle-aged woman with a history of Roux-en-Y gastric bypass who presented with dyspnoea and fatigue and was found to have thrombocytopenia and a non-immune haemolytic anaemia. Work-up for haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, paroxysmal nocturnal haemoglobinuria, infection, malignancy and autoimmune conditions was unremarkable. Her haemolytic anaemia and thrombocytopenia resolved with folate replenishment. She was diagnosed as likely having pseudo-TMA secondary to folate deficiency.

  • Malignant and Benign haematology
  • Malnutrition

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  • Contributors EL wrote and prepared the manuscript and figures. SK and MG contributed to the literature search and editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.