Microangiopathic hemolytic anemia and leukoerythroblastic blood film heralding bone marrow metastatic gastroesophageal adenocarcinoma.
Despite modern technological advancements in laboratory hematology, the blood film remains an important diagnostic aid. Herein, we report the case of a patient with a history of gastric cancer, who presented seven years following apparently successful surgery and adjuvant chemo-radio-therapy, with blood film findings of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and leukoerythroblastosis (LEB). Although mimicking features of thrombotic thrombocytopenic purpura (TTP), subsequent bone marrow examination instead revealed an association with occult recurrence of necrotic, metastatic gastric adenocarcinoma. This case report and literature review highlight these rare, but important, hematological manifestations of gastric cancer, and the importance of astute laboratory and bone marrow investigations in preventing delays in appropriate treatment of the underlying malignancy.
Rauh
Michael J
MJ
Haematopathology Residency Program, University of Toronto, Toronto, Canada.
Al Habeeb
Ayman
A
Chang
Hong
H
D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary* / Q000628:therapy; D000750:Anemia, Myelophthisic / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D001706:Biopsy; D001856:Bone Marrow Examination; D019046:Bone Marrow Neoplasms / Q000150:complications / Q000556:secondary* / Q000628:therapy; D004943:Esophagogastric Junction / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D011237:Predictive Value of Tests; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy