Occult Disseminated Metastatic Breast Carcinoma Presenting As Acquired Thrombotic Thrombocytopenic Purpura

Cancer-related microangiopathic hemolytic anemia (MAHA) is a rare and life-threatening
condition. We present a patient who had been treated for invasive lobular breast carcinoma
in clinical remission with fever and hemolytic anemia. The peripheral blood film showed
MAHA and thrombocytopenia, and a functional deficiency of ADAMTS13 activity of 23% consistent with acquired thrombotic thrombocytopenic purpura. Bone marrow aspirate and trephine biopsy confirmed metastatic carcinoma. Further evaluation revealed the involvement
of multiple bone sites without recurrence of the primary tumor. The patient received a daily
plasma exchange with cryosupernatant and was pulsed with corticosteroids. MAHA related
to breast cancer appears to be a rare occurrence