Haematologica 2002; 87:(10)EIM22
[Medline] [prev] [index] [next]Microangiopathic hemolytic anemia as first appearance of relapse of lung carcinoma
Pierangelo Spedini, Laura Blanzuoli°
Divisione di Medicina II, Sezione di Ematologia, Servizio di Anatomia ed Istologia Patologica°, Istituti Ospitalieri di Cremona, Cremona, ItalyA 68-year old man was referred to our hospital because of fever, asthenia, headaches and weight loss. He had a history of lung carcinoma 20 months earlier.
On admission, physical examination revealed petechiae and ecchymoses on his legs, cutaneous jaundice and mild splenomegaly. The complete blood count was: hemoglobin 5.9 g/dL, platelets 89x109/L, white blood cells 12.8x109/L; a peripheral blood smear showed neutrophils 70%, lymphocytes 20%, myelocytes 7%, metamyelocytes 3%, and erythroblasts 4%. An important red cell fragmentation was also present (Figure 1). Biochemical tests showed ESR=110 mm, increased serum lactic dehydrogenase (3470 U/L, normal range 0-450 U/L), hyperbilirubinemia (total=6.4 mg/dL, normal range 0-1.4; indirect=5.9, normal range 0-0.8), absent haptoglobin levels. Laboratory evidence of disseminated intravascular coagulation was present. A bone marrow trephine biopsy was performed showing decreased cellularity with massive aggregates of carcinoma tumor cells (Figure 2). Moreover a chest CT scan showed a relapse of lung carcinoma. A diagnosis of microangiopathic hemolytic anemia as first manifestation of relapse of the lung carcinoma was made.References