Microangiopathic hemolytic anemia with hyposplenism Barbara J. Bain* and Emma Fosbury A 71-year-old woman with known alcoholic cirrhosis and a past history of bilateral breast carcinoma presented with seiz- ures, abdominal pain, and melena. She had splenomegaly (spleen length 15.8 cm on computerized tomography). Her blood count was: white cell count 26.6 3 10 9 /l, hemoglobin concentration 9 g/dl, and platelet count 58 3 10 9 /l. A blood film showed numerous red cell fragments and was leucoerythroblastic (left Image 1). Polychromatic macrocytes were pres- ent. These features indicated a microangiopathic hemolytic anemia and suggested possible bone marrow infiltration. In addition, there were Howell-Jolly bodies and occasional Pappenheimer bodies (right Image 1) indicating hyposplenism. Bone marrow aspirate and trephine biopsy confirmed bone marrow infiltration. Hyposplenism in patients with acute hemolytic anemia can be due to functional overload of splenic macrophages that have ingested damaged red cells. In patients with carcinomatosis, splenic infiltration can also be responsible [1]. Features of hyposplenism and splenomegaly can coex- ist when the spleen is functionally overloaded, or infiltrated by hemopoietic or non-hemopoietic cells, or when there is dep- osition of amyloid. Reference 1. Brace W, Bain B, Walker M, Catovsky D. Teaching cases from the Royal Marsden Hospital Case 9: An elderly patient with unusual circulating cells. Leuk Lymphoma 1995;18:529–530. Department of Haematology, Faculty of Medicine, St Mary’s Hospital Cam- pus of Imperial College, St Mary’s Hospital, London, United Kingdom Conflict of Interest: Nothing to report. *Correspondence to: Barbara J. Bain, Department of Haematology, St Mary’s Hospital Campus of Imperial College, Faculty of Medicine, St Mary’s Hospital, Praed Street, London W2 1NY. E-mail: [email protected] Received for publication 24 September 2008; Accepted 25 September 2008 Am. J. Hematol. 84:242, 2009. Published online 30 September 2008 in Wiley InterScience (www.interscience. wiley.com). DOI: 10.1002/ajh.21301 Morphology Update V V C 2008 Wiley-Liss, Inc. American Journal of Hematology 242 http://www3.interscience.wiley.com/cgi-bin/jhome/35105

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Microangiopathic hemolytic anemia with hyposplenism

Barbara J. Bain* and Emma Fosbury

A 71-year-old woman with known alcoholic cirrhosis and a past history of bilateral breast carcinoma presented with seiz-ures, abdominal pain, and melena. She had splenomegaly (spleen length 15.8 cm on computerized tomography). Herblood count was: white cell count 26.6 3 109/l, hemoglobin concentration 9 g/dl, and platelet count 58 3 109/l. A bloodfilm showed numerous red cell fragments and was leucoerythroblastic (left Image 1). Polychromatic macrocytes were pres-ent. These features indicated a microangiopathic hemolytic anemia and suggested possible bone marrow infiltration. Inaddition, there were Howell-Jolly bodies and occasional Pappenheimer bodies (right Image 1) indicating hyposplenism.Bone marrow aspirate and trephine biopsy confirmed bone marrow infiltration. Hyposplenism in patients with acute hemo-lytic anemia can be due to functional overload of splenic macrophages that have ingested damaged red cells. In patientswith carcinomatosis, splenic infiltration can also be responsible [1]. Features of hyposplenism and splenomegaly can coex-ist when the spleen is functionally overloaded, or infiltrated by hemopoietic or non-hemopoietic cells, or when there is dep-osition of amyloid.

Reference1. Brace W, Bain B, Walker M, Catovsky D. Teaching cases from the Royal Marsden Hospital Case 9: An elderly patient with unusual circulating cells. Leuk Lymphoma

1995;18:529–530.

Department of Haematology, Faculty of Medicine, St Mary’s Hospital Cam-pus of Imperial College, St Mary’s Hospital, London, United Kingdom

Conflict of Interest: Nothing to report.

*Correspondence to: Barbara J. Bain, Department of Haematology, StMary’s Hospital Campus of Imperial College, Faculty of Medicine, St Mary’sHospital, Praed Street, London W2 1NY. E-mail: [email protected]

Received for publication 24 September 2008; Accepted 25 September 2008

Am. J. Hematol. 84:242, 2009.

Published online 30 September 2008 in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/ajh.21301

Morphology Update

VVC 2008 Wiley-Liss, Inc.

American Journal of Hematology 242 http://www3.interscience.wiley.com/cgi-bin/jhome/35105