ISSN 2997-1036
International Journal of Hematology | Vol. 4, No. 11, November 2013 | pp. 81–88
DOI: 10.46882/2013/IJH/000047
Case Report
Title: Severe microangiopathic hemolytic anemia secondary to metastatic gastric adenocarcinoma mimicking thrombotic thrombocytopenic purpura
Names of Authors: K. L. Musa¹, M. N. Lawal², O. P. Dikko³
Authors’ Affiliations: ¹Department of Haematology, Federal Medical Centre, Katsina, Nigeria; ²Department of Oncology, Bayero University, Kano, Nigeria; ³Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Abstract: Cancer-associated microangiopathic hemolytic anemia is a rare, severe paraneoplastic syndrome that can clinically mimic thrombotic thrombocytopenic purpura, leading to diagnostic delays. We report a 45-year-old male presenting with severe fatigue, weight loss, and widespread petechiae lasting 3 weeks. Laboratory investigations revealed a microangiopathic hemolytic anemia profile: hemoglobin 5.4 g/dl, platelet count 18 × 10⁹/L, lactate dehydrogenase 2,150 U/L, and numerous schistocytes (8.5%) on peripheral blood film examination. Coagulation screens showed a normal prothrombin time and normal fibrinogen levels. Initial treatment for suspected thrombotic thrombocytopenic purpura with daily therapeutic plasma exchange was initiated, but it yielded no hematological or clinical improvement after 5 consecutive sessions. ADAMTS13 activity was subsequently reported as normal (68.0%), ruling out classic idiopathic thrombotic thrombocytopenic purpura. A subsequent bone marrow trephine biopsy revealed extensive infiltration by mucin-secreting signet-ring malignant cells. Upper gastrointestinal endoscopy confirmed a primary gastric adenocarcinoma. This case demonstrates that metastatic mucinous adenocarcinomas can present with severe microangiopathic hemolysis due to tumor-induced microvascular remodeling. Recognizing this diagnostic entity prevents ineffective plasma exchange and guides appropriate systemic palliative chemotherapy.
Keywords: Microangiopathic hemolytic anemia, gastric adenocarcinoma, schistocytes, thrombotic thrombocytopenic purpura, plasma exchange
Manuscript Timeline: Received: August 18, 2013; Revised: September 22, 2013; Accepted: October 12, 2013; Published: November 15, 2013