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Mechanisms of hemolysis in patients with vitamin B12 deficiency are not entirely understood, it is believed that the hemolysis results from intramedullary destruction as well as from pseudo-thrombotic microangiopathy (TMA) that accompanies vitamin B12 deficiency.[5,6] The patient reported here had severe microangiopathic hemolysis as evidenced by the very low levels of serum haptoglobin, with elevated LDH and indirect hyperbilirubinemia as well as the presence of schistocytes in the peripheral blood smears