Cancer Associated Microangiopathic Hemolytic Anemia: A Rare Paraneoplastic Syndrome

Microangiopathic hemolytic anemias (MAHA) are secondary to damage of RBCs because of endothelial vascular damage of blood vessels leading to hemolysis. MAHAs are characterized by negative coombs test and are associated with several etiologies that include can be either hereditary complement or ADAMTS13 deficiency or sepsis or malignancy. Cancer associated MAHA (CA-MAHA) is a rare and is seen in patients with advanced metastatic disease. CA-MAHA has significant mortality rate and chemotherapy is the only therapeutic option, however overall survival is poor. Here we, present a rare case of CA-MAHA secondary to metastatic signet ring cell carcinoma with an unknown primary. In patients, when the cause of progressive MAHA is unknown, the possibility of cancer associated MAHA must be considered and a comprehensive work up for an underlying malignancy must be done.