Disseminated gastric carcinoma in disguise—presentation as microangiopathic haemolytic anemia with bone marrow necrosis

Abstract

Cancer related microangiopathic hemolytic anemia (MAHA) and bone marrow necrosis (BMN) are two rare and distinct clinicopathological entities reported in patients with disseminated malignancy. When they emerge as initial findings in a previously undetected case of malignancy, the diagnosis is often missed resulting in inappropriate management. We report the extremely rare association of cancer related MAHA and BMN as the first presentation of unsuspected disseminated gastric carcinoma in a 63 years old male. Early institution of chemotherapy is the only effective option for both these conditions, though with little improvement in outcome. This emphasises the need for increased awareness of such presentations in advanced malignancies.

Hemolytic Anemia of Malignancy: A Case Study Involving Signet Ring Cell Metastatic Breast Cancer with Severe Microangiopathic Hemolytic Anemia

“…Microangiopathic hemolytic anemia was first characterized by Brain and colleagues based on the finding of fragmented red blood cells in peripheral blood smears [1]. While there are many potential causes for hemolytic anemia, one uncommon cause is due to the presence of cancer with likely origin in gastric, breast and lung [2, 3, 4, 5]. Here we discuss a case involving metastatic breast cancer presenting with severe hemolytic anemia and renal failure secondary to thrombotic microangiopathy from underlying malignancy.…”

Microangiopathic hemolytic anemia as initial presentation of recurrent colon cancer

“…CR-MAHA with no apparent systemic manifestation of malignancy may be often included in such cases. This leads to the trial of plasma exchange, which is seldom effective and may cause unnecessary risk of complication in CR-MAHA cases [ 6 7 8 ]. Presenting laboratory findings in this case are indicative of overt DIC, although a diagnosis of DIC should be based on both clinical and laboratory features.…”

“…Although BM metastasis is commonly found in CRMAHA, it is seldom an initial presenting feature of malignant tumor. BM metastasis from colon cancer is very rare, particularly when encountered in the absence of usual distant metastases such as liver and lungs [ 8 9 10 ]. Generally, BM study is not routinely considered in solid tumor workup; however, PB slide examination is performed in almost all known or suspected cancer cases as a simple screening tool.…”