Bone marrow metastases presenting as low backache, severe anemia refractory to blood transfusion - A case report

Even though anemia is common in malignancy, it is more so in bone marrow metastases. Type and severity of anemia in malignancy depend on the underlying etiology, most of the time being multifactorial in origin. A 39 year female presented with low backache of 3 months duration and left sided sciatica of 3 weeks duration. Based on the laboratory findings of anemia, polychromasia, thrombocytopenia, schistocytes, tear drop cells, diagnosis of leukoerythroblastic anemia (LEA) with microangiopathic hemolytic anemia (MAHA) was considered. Hemoglobin was persistently low even after 4 units of blood transfusion. Bone marrow aspiration revealed infiltration by malignant epithelial tumor, most likely adenocarcinoma. Evidence of MAHA together with LEA changes on peripheral smear is virtually diagnostic of malignant disease with secondary deposits in the marrow and replacement of marrow by tumor cells may not be the sole cause of severe anemia, in contrast to that seen in acute leukemia.