Abstract
Vitamin B12 deficiency can present with hematological and neuropsychiatric manifestations and is most commonly due to pernicious anemia in adults. A rare presentation is pseudo-thrombotic microangiopathy, which mimics thrombotic microangiopathies and may result in unwarranted treatment, including plasmapheresis. This condition must be considered in patients presenting with features of microangiopathic hemolytic anemia, and prompt treatment with vitamin B12 supplementation should be initiated. Although the laboratory findings of pseudo-thrombotic microangiopathy are similar to those of thrombotic thrombocytopenic purpura, there are some significant differences, such as in the reticulocyte production index. This report presents the case of a patient with pseudo-thrombotic microangiopathy caused by vitamin B12 deficiency.