title: [Severe microangiopathic hemolytic anemia as first manifestation of a CUP syndrome. Rapid hematologic remission under polychemotherapy].
abstract: BACKGROUND
  Microangiopathic hemolytic anemia (MAHA) represents a rare manifestation of malignant tumors. This complication, which is mainly lethal within a few weeks, is most commonly observed in association with mucin-producing adenocarcinomas, especially gastric cancer. The pathogenesis of tumor-associated mechanical hemolysis remains unclear. A standard therapy of this hematologic disturbance is not established.
  
  
  METHODS
  The authors report on a 51-year-old patient, who presented himself in their clinic with severe anemia, thrombopenia and deterioration of his general condition. Extensive investigations revealed signet-ring carcinoma metastases in the whole vertebral column, pelvis and bone marrow. The primary tumor could neither be located endoscopically nor in imaging examinations. Under palliative chemotherapy with cisplatin, epirubicin and 5-fluorouracil continuous infusion, a rapid objective and subjective improvement could be achieved, which was reflected in normalization of the blood picture and regression of the osteoplastic bone metastases indicating partial remission. 9 months later, the patient died because of a new progression of his disease.
  
  
  CONCLUSIONS
  MAHA can be the first manifestation of malignant tumors. Upon the diagnosis of a MAHA, rapid diagnostics should be done to detect a possible underlying tumor, as effective antineoplastic therapy can induce both tumor and hematologic remission.
authors.affiliation: Medizinische Klinik II, Städtisches Klinikum Pforzheim, Akademisches Lehrkrankenhaus der Universität Heidelberg, Pforzheim. abdelsamie@ngi.de
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel Samie
authors.forename: Bettina
authors.initials: B
authors.lastname: Sandritter
authors.forename: Lorenz
authors.initials: L
authors.lastname: Theilmann
mesh_terms: D000743:Anemia, Hemolytic / Q000188:drug therapy / Q000209:etiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000188:drug therapy; D010166:Palliative Care; D010257:Paraneoplastic Syndromes / Q000188:drug therapy / Q000209:etiology*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*