Abstract
We report a case of insulin-dependent diabetes mellitus (IDDM) associated with diabetic microangiopathic hemolytic anemia (MHA).
The patient was a 23-year-old woman who had a history of diabetes for 14 years, with significant diabetic triopathy (diabetic retinopathy of Scott II a, diabetic glomerulosclerosis and peripheral neuropathy of upper and lower extremities). She had required daily injections of insulin since the age of 9 years and started intensive therapy with continuous subcutaneous insulin injection of 21 years of age. She was admitted to our hospital because of generalized edema, hypertension and severe anemia, at the age of 23 years. Laboratory data showed increased LDH (857 IU/l), renal failure (Cr 1.8mg/dl, BUN 36mg/dl), anemia (hemoglobin concentration 6.5g/dl, hematocrit 19.2%) and decreased haptoglobin level. Marked fragmentation of red cells was seen in peripheral blood smears. There were no enzyme deficiencies leading to hemolytic anemia. Moderate bone marrow hyperplasia was found. The 51Cr disappearance half-time was decreased to 14 days. In spite of poor control of blood glucose levels, Hb A1 and Hb A1c concentrations were low. These data indicated severe microangiopathic hemolytic anemia. After continuous ambulatory peritoneal dialysis therapy, her blood pressure was normalized and anemia improved. Microangiopathic hemolytic anemia may be produced by diabetic microangiopathy and hypertensive vascular injury.
