Abstract
We report a case of diabetic microangiopathic hemolytic anemia (1¥111A) caused by steroid withdrawal. On March 1989, a 61-year-old woman presented with diabetes mellitus complicated only by simple retinopathy. During her first admission, in March 1989, treatment consisted of glybenclamide and glycemic control was well maintained. Her local physician had been prescribing steroids to her arthritis for 12 years. She discontinued taking the steroids on Dec., 1989 when her local physician died. In Feb. 1990, she was admitted because of proliferative retinopathy, marked proteinuria, hypertension and severe anemia (hemoglobin concentration 6.5 g/d/, hematocrit 19.3%). Her peripheral blood smear contained fragmented erythrocytes associated with shortened Cr-red cell survival (12 days). These findings indicated microangiopathic hemolytic amenia. The clinical course suggests that the diabetic MHA may have been associated with steroid withdrawal. Steroids are known to affect platelets. Platelet abnormalities associated with steroid withdrawal may play a role in the pathogenesis of diabetic MI IA.
