The challenge of microangiopathic hemolytic anemia

Abstract

Microangiopathic hemolytic anemia (MAHA) is a Coomb's-negative hemolytic anemia characterized by red cell fragmentation (schistocytes). Thrombotic microangiopathy anemia, including thrombotic thrombocytopenia and hemolytic-uremic syndrome, malignant hypertension, preeclampsia are among the most common causes. We present a case of MAHA presenting with thrombocytopenia initially diagnosed as MAHA secondary to thrombotic thrombocytopenic purpura and received five sessions plasmapheresis without improvement but with worsening of anemia and thrombocytopenia. On further inquiry, glucose-6-phosphate dehydrogenase deficiency was identified, and the patient showed dramatic recovery after the trial of B12 and folate.

Keywords

• Fragmentation syndrome
• glucose-6-phosphate dehydrogenase deficiency
• megaloblastic anemia