Dr. Hend A. M. Attia
Microangipathic Hemolytic Anaemia (MAHA) is a medical term used to describe the anaemia that is caused by physical damage of the red cells. The mechanical distruction of red cells is attributed to the pathologically altered small blood vessels by fibrin deposition and platelet activation. A case of a 55 year old female with breast cancer presented with acute onset of cancer related (CR)-MAHA. A panel of investigations revealed Coombs-negative hemolysis of red blood cells with schistocytes in the peripheral blood and marked thrombocytopenia. Bone marrow examination results confirmed the infilteration of the bone marrow by nonhematopoietic cells of metastatic carcinoma. Although, the exact underlying pathogenesis was not definitely portrayed, this case opens the discussion for several known pathways that can contribute to CR-MAHA in patients with cancer. MAHA is a presenting feature of Hemolytic uremic syndrome (HUS), Thrombotic thrombocytopenic purpura (TTP) and Disseminated intravascular Coagulation (DIC). Its occurrence in cases with late stage of metastatic malignant tumors has been reported. CR-MAHA is an emergency condition that needs early diagnosis based on the medical history, clinical assessment and appropriate investigations which may contribute to a controlled outcome.