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IMAGE IN HEMATOLOGY
Year : 2016  |  Volume : 7  |  Issue : 4  |  Page : 152

Microangiopathic hemolytic anemia in active ulcerative colitis


1 Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Malappuram, Kerala, India
2 Department of Pathology, M.E.S. Medical College, Perinthalmanna, Malappuram, Kerala, India

Date of Web Publication18-Jan-2017

Correspondence Address:
Dr. Mansoor C Abdulla
Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Malappuram - 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5127.198513

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How to cite this article:
Abdulla MC, Alungal J, Mohammed BA, Salih M. Microangiopathic hemolytic anemia in active ulcerative colitis. J Appl Hematol 2016;7:152

How to cite this URL:
Abdulla MC, Alungal J, Mohammed BA, Salih M. Microangiopathic hemolytic anemia in active ulcerative colitis. J Appl Hematol [serial online] 2016 [cited 2020 Aug 8];7:152. Available from: http://www.jahjournal.org/text.asp?2016/7/4/152/198513

A 58-year-old female was admitted with abdominal pain for 2 years and diarrhea for 1 year. Examination showed tenderness over hypogastrium and right iliac region. Hemoglobin was 10.3 g/dl (normocytic, normochromic), total white blood cell count 4900/µl, platelet count 0.94 × 109/L, and erythrocyte sedimentation rate 56 mm in 1 h. Peripheral smear showed normocytic normochromic anemia with evidence of microangiopathic hemolysis; occasional microspherocytes, schistocytes, polychromatophilic cells, nucleated red blood cells (RBCs), and mild thrombocytopenia [[Figure 1] upper panel]. Her corrected reticulocyte count was 4%, serum lactate dehydrogenase 1821 U/L, and the direct and indirect Coombs tests were negative. Prothrombin time and partial thromboplastin time were normal. Stool and blood cultures were sterile. Liver function tests showed indirect hyperbilirubinemia with normal enzymes. Colonoscopy revealed Grade 3 left-sided colitis. Colonoscopic biopsy showed ulcerative colitis [[Figure 1] lower panel]. She was started on mesalazine and steroids with which she improved.
Figure 1: Upper panel - Peripheral smear showing microangiopathic hemolysis characterized by microspherocytes, schistocytes, polychromatophilic cells, and mild thrombocytopenia (Leishman, ×100). Lower panel - colonic biopsy showing ulcerative colitis characterized by cryptitis, crypt abscess, and crypt destruction (H and E, ×40)

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Microangiopathic hemolytic anemia (MAHA) is characterized by fragmented RBCs and thrombocytopenia that is nonimmune in nature. MAHA can be associated with a variety of diseases including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, disseminated intravascular coagulation, preeclampsia, eclampsia, malignant hypertension, drugs, and autoimmune disorders. Hemolysis in ulcerative colitis may be due to autoimmune hemolytic anemia. MAHA as a manifestation of active ulcerative colitis is extremely rare.

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