Antiphospholipid syndrome with hemophilia B: a case report represented by recurrent thrombosis/ bleeding attacks

Antiphospholipid syndrome is a disease presenting with arterial/ venous thrombosis and obstetrical complications. Pulmonary embolism is an important pulmonary complication of antiphospholipid syndrome, whereas, intra-alveolar hemorrhage is a rarely encountered manifestation. Hemophilia B is caused by factor IX deficiency that results in prolonged oozing after injuries and/or surgery, and delayed or recurrent bleeding prior to complete wound healing. Antithrombotic therapy may be used for recurrent hemostatic attacks in APS; but if there is a hemostatic defect, it may lead to serious bleeding complications. Here, we present a case of antiphospholipid syndrome accompanied by heterozygote methylene tetrahydrofolate reductase gene mutation [MTHFR] mutation and hemophilia B

Megaloblastic anemia patient admitted with pancytopenia and walking difficulty with normal vitamin B12 and MCV levels

Vitamin B12 deficiency may cause hematologic, gastrointestinal, psychiatric and neurological symptoms. Sub-acute combined degeneration of spinal cord, which develops in the deficiency of vitamin B12, may be reversible in case of early diagnosis and treatment. We describe the management of a 50-years old female who got admitted with pancytopenia and elevated LDH, with walking difficulties since last 15 days. B12 and folic acid levels were found in normal ranges. Megaloblastic changes were observed in the bone marrow examination. Abnormal hyperintence signal changes were observed in T2-weighed cervical spinal cord Magnetic Resonance Imaging in posterior row. Due to the high homocysteine level, treatment with parenteral B12 vitamin was initiated. Following the 3-months treatment, hematologic counts and neurological symptoms of the patient were found to be completely recovered at the control visit. Vitamin B12 deficiency should be considered for the patients with pancytopenia, elevated LDH levels and neurological symptoms, even if vitamin B12 and MCV levels are in normal ranges. Vitamin B12 deficiency should be confirmed with the additional assays, such as, the assessment of serum homocysteine and methylmalonic acid levels, and the treatment should be started promptly