Bactrim Induced Hemolysis and Thrombocytopenia in a Patient with Pernicious Anemia

Aijan Ukudeyeva,* A. Nassereddin, A. Banerjee, Natalya Kozlova, N. Shabarek

Lincoln Medical and Mental Health Center. Bronx, NY, USA

*Corresponding author: Aijan Ukudeyeva, MD. Department of Internal Medicine, Lincoln Medical and Mental Health Center,Bronx, NY, USA. E-mail:

Published: December 15, 2017.  doi: 10.21103/Article7(4)_CR2


This case report presents a 87-year-old female who had a history of pernicious anemia and was given Bactrim, which suppressed folic acid and caused a more profound anemia, thrombocytopenia and hemolysis. 

pernicious anemia ● thrombocytopenia ● hemolysis ● Bactrim
  1. Andres E, Serraj K. Optimal management of pernicious anemia. J Blood Med. 2012; 3: 97–103. doi: 10.2147/JBM.S25620. Epub 2012 Sep 10.
  2. Schrier SL, Motil KJ, Tirnauer JS. Causes and pathophysiology of vitamin B12 and folate deficiency. UpToDate. Available from:
  3. DailyMed - TRIMETHOPRIM- trimethoprim tablet. Available from:
  4. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009;89(2):693S–6S. doi: 10.3945/ajcn.2008.26947A.
  5. Andrès E, Affenberger S, Zimmer J, Vinzio S, Grosu D, Pistol G, et al. Current hematological findings in cobalamin deficiency. A study of 201 consecutive patients with documented cobalamin deficiency. Clin Lab Hematol. 2009;28(1):50–6.
  6. Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171(3):251–9.
  7. Andrès E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J, Kaltenbach G. B12 deficiency: a look beyond pernicious anemia. J Fam Pract. 2007;56(7):537–42.
  8. Koury MJ, Horne DW. Apoptosis mediates and thymidine prevents erythroblast destruction in folate deficiency anemia. Proc Natl Acad Sci U S A. 1994;91(9):4067-71.
  9. Kobrinsky NL, Ramsay NK. Acute megaloblastic anemia induced by high-dose trimethoprim-sulfamethoxazole. Ann Intern Med. 1981;94(6):780-1.
  10. FDA Access Data. Bactrim. Available from:
  11. Yeruva SL, Munchandani RP, Oneal P. Pernicious Anemia with Autoimmune Hemolytic Anemia: A Case Report and Literature Review. Case Rep Hematol. 2016;2016:7231503. doi: 10.1155/2016/7231503.
  12. Randhawa J, Ondrejka SL, Setrakian S, Taylor H. What should I know before ordering a bone marrow aspiration/biopsy in patients with vitamin B12 deficiency? BMJ Case Rep. 2013 Jul 8;2013. pii: bcr2013010200. doi: 10.1136/bcr-2013-010200.
  13. Tefferi A, Pruthi RK. The biochemical basis of cobalamin deficiency. Mayo Clin Proc. 1994; 69(2):181-6.
  14. Wollman MR, Penchansky L, Shekhter-Levin S. Transient 7q- in association with megaloblastic anemia due to dietary folate and vitamin B12 deficiency. J Pediatr Hematol Oncol. 1996;18(2):162-5
  15. Kim M, Lee SE, Park J, Lim J, Cho BS, Kim YJ, et al. Vitamin B(12)-responsive pancytopenia mimicking myelodysplastic syndrome. Acta Haematol. 2011;125:198–201 doi: 10.1159/000322941.

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International Journal of Biomedicine. 2017;7(4):327-329. ©2017 International Medical Research and Development Corporation. All rights reserved.