Herein, we present a case of a young man with a history of previously treated hepatitis C virus (HCV) infection presenting with a syndrome concerning for TTP: MAHA, thrombocytopenia, and dizziness with gait ataxia. [link.springer.com]

First, men of African or African-American ancestry who are hemizygous for the A– alloenzyme (which is present at normal levels in reticulocytes) can have normal G6PD levels because the reticulocyte count is high after hemolysis. [mytestdiagnostics.com]

Proportion of peripheral oval's diameters AP Area proportion Area of cell/area of central pallor DV Deviation value shape geometric factor/cell area TF Target flag Rise if central pallor has another object CP Central pallor It is 1 if central pallor p presents [sites.kowsarpub.com]

• Fatigue

  The patient also noted feeling much better, with full resolution of his presenting dizziness, fatigue, and gait balance issues. [link.springer.com]

• Malaise

  […] which he had finished a full course of glecaprevir and pibrentasvir 2 weeks prior, presented to our emergency department with several weeks of insidiously worsening dizziness and near falls, generalized weakness, dyspnea on exertion, blurry vision, and malaise [link.springer.com]

• Hematuria

  He had not experienced any unusual bleeding including melena, bloody diarrhea, hematuria, or hematemesis, and did he note any episodes of icterus or jaundice. There was no travel or unusual food intake before presentation. [link.springer.com]

• Headache

  Common side effects noted were gastrointestinal discomfort, headaches, and fatigue, but no significant mention of any hematological processes was made [20]. [link.springer.com]

Further workup identified an undetectably low vitamin B12 level with profound elevations in both homocysteine and methylmalonic acid (MMA) levels. [link.springer.com]

Prompt recognition and treatment is essential to reduce morbidity and mortality. [link.springer.com]

First, it permits a speedy provisional diagnosis, and initiation of appropriate treatment in severely anemic patients while assay results are pending. [mytestdiagnostics.com]

It is also interesting to consider the etiology of the vitamin B12 deficiency leading to the presentation. [link.springer.com]

The pathophysiology is thought to be ineffective erythropoiesis due to impaired deoxyribonucleic acid (DNA) synthesis, which results in early destruction of poorly formed red blood cell and platelet precursors within the bone marrow space. [link.springer.com]

PDQ Screening and Prevention Editorial Board (2018) Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version. PDQ Cancer Information Summaries [Online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65730/. [link.springer.com]