Pendse Avani A, Edgerly Claire H, Fedoriw Yuri
Lab Med. 2014 Spring;45(2):132-5. doi: 10.1309/lm6fenwrxx5grwbt.
Hemolytic anemia can complicate the development of a variety of solid tumors and hematologic malignancies. Although patients may have an established diagnosis with documented metastases, microangiopathic hemolytic anemia (MAHA) can be a presenting feature of an occult malignancy. Prompt diagnosis is essential because conditions that mimic the symptoms of MAHA, including thrombotic thrombocytopenic purpura, have different prognoses and therapeutic options. Although the exact pathogenesis is not yet delineated, we present herein a case of cancer-associated MAHA and discuss the known pathways that can contribute to the initiation and propagation of hemolytic anemia in patients with cancer. The patient is a 69-year-old woman with breast carcinoma that had metastasized to her rectum, urinary bladder, and brain. She eventually developed progressive decline in her functional status, with intermittent epistaxis and melena. The results of laboratory studies revealed hemolytic anemia and thrombocytopenia; results of a bone-marrow biopsy confirmed the involvement by metastatic carcinoma. The patient received red blood cell and platelet transfusions and was discharged to hospice care after clinical stabilization. She died soon thereafter.
溶血性贫血可使多种实体瘤和血液系统恶性肿瘤的病情复杂化。尽管患者可能已确诊并有转移记录，但微血管病性溶血性贫血（MAHA）可能是隐匿性恶性肿瘤的首发特征。及时诊断至关重要，因为一些可模拟MAHA症状的疾病，包括血栓性血小板减少性紫癜，有着不同的预后和治疗选择。虽然确切的发病机制尚未明确，但我们在此报告一例癌症相关的MAHA病例，并讨论已知的可导致癌症患者溶血性贫血发生和发展的途径。该患者为一名69岁女性，患有已转移至直肠、膀胱和脑的乳腺癌。她最终出现功能状态逐渐下降，伴有间歇性鼻出血和黑便。实验室检查结果显示为溶血性贫血和血小板减少；骨髓活检结果证实有转移性癌浸润。患者接受了红细胞和血小板输注，临床病情稳定后出院接受临终关怀。此后不久她便去世。
