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
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