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Microangiopathic Hemolytic Anemia in Metastatic Carcinoma: Report of Eight Cases

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▸Requests for reprints should be addressed to H.-P. Lohrmann, M.D., National Cancer Institute, Bldg. 10, Room 3B11, Bethesda, MD 20014.

Ulm, Germany

Ann Intern Med. 1973;79(3):368-375. doi:10.7326/0003-4819-79-3-368
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Of eight patients with metastatic carcinoma and microangiopathic hemolytic anemia, four presented with microangiopathic hemolytic anemia, inducing search for a tumor. The anemia, characterized by schistocytes and "microspherocytes," was of acute onset and rapid progression. Thrombocytopenia and intravascular tumor growth or intravascular fibrin precipitations, or both, were found in seven patients: disseminated intravascular coagulation was clinically detected in two. Heparin did not improve hemolysis or thrombocytopenia. Intravascular coagulation probably is the major cause of microangiopathic hemolytic anemia in metastatic carcinoma, inducing red cell fragmentation on fibrin strands. Interaction of red cells with intravascular tumor cells may cause additional fragmentation. The anemia seems to be predominantly extracorpuscular in origin. Microangiopathic hemolytic anemia apparently is a common complication of metastatic carcinoma. It may be the presenting sign of carcinoma and may indicate metastases in patients with previously diagnosed tumor.





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