Abstract
A 45-year-old male was admitted to the Keio University Hospital because of severe anemia. He was emaciated and slightly icteric. There was no lymphadenopathy or splenomegaly, but sternal tenderness was present and the liver edge was felt 2.5 fingerbreadths below the costal margin. On fundoscopy, right retinal hemorrhage was noticed.
Laboratory examination revealed severe normochromic anemia as well as thrombocytopenia. The leukocyte counts were normal. The blood film disclosed leukoerythroblastic picture with marked red cell fragmentation. The reticulocyte counts were elevated. Hemosiderin granules were detected in the urine. Sucrose hemolysis test and acidified serum test (Ham) were found positive. Indirect bilirubin, lactic acid dehydrogenase, alkaline phosphatase and serum iron were elevated.
Because of these laboratory data, a diagnosis of microangiopathic hemolytic anemia was made. The patient died of cerebral hemorrhage on the fourth hospital day despite of prednisolone therapy.
Autopsy revealed multiple mucosal cancer of the stomach with generalized metastases to lungs, mesenteric lymph nodes, liver and bone marrow. Careful microscopic observation could not demonstrate the presence of thrombotic microangiopathy or tumor cell thrombi.
The significance of the positive sucrose hemolysis test and acidified serum test was discussed.
