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Microangiopathic Haemolytic Anemia Associated with Bone Marrow Metastasis in a 12 Year Old Child

Ruchi Gupta, Khaliqur Rahman, Surabhi, Manish K Singh and Seema Sharma

A 12 year old female child presented to the emergency department of our institute with complaints of generalized weakness and lethargy for three months and rapidly progressive breathlessness of 15 days duration. There was history of episodes of hematemesis and melena. Examination was notable for presence of tachypnea, tachycardia, severe pallor, mild pedal edema, right sided pleural effusion, mild hepatomegaly and splenomegaly. Investigations revealed elevated serum lactate dehydrogenase levels, 2127 IU/L, unconjugated hyperbilirubinemia, 3.3 mg/dl, haemoglobin 8.3 g/dl, total leucocyte count, 18×109/L, platelet count, 30×109/L, and a reticulocyte count of 23.3%. Peripheral blood smear showed numerous schistocytes, polychromasia, circulating nucleated red blood cells