胃癌合并肿瘤相关性微血管病性溶血性贫血一例报道并文献复习

目的探讨胃癌合并肿瘤相关性做血管病性溶血性贫血（cancer—relatedMieroangiopathicHemolyticAnemia，CR—MAHA）的临床特点及预后，提高对该病的认识。方法报道1例胃癌合并CR—MAHA并进行分析，并对国内文献进行总结分析。结果共检索到病例17例，加本病例共18例，其中男lO例（55．56％），女8例（44．44％），男：女为1．13：l；年龄23～68岁，中位年龄4l岁；均经胃镜活检行病理确诊，均为腺癌；其中骨髓发现转移癌细胞8例。均以与胃癌不相符的进行性贫血及酱油样尿为主要临床表现，大多伴淋巴结等远处转移；均出现中重度贫血，外周血可见破碎红细胞；生存期较短，中位生存期23天。结论胃癌合并CR—MAHA临床较少见，表现为与原发病不相符的血管内溶血性贫血，多伴广泛转移，病理类型为腺癌，出现中重度贫血。预后较差，生存期短，化疗可能能改善病人预后。

Gastric cancer-related microangiopathic hemolytic anemia： a case report and literature review

Objective To investigate the clinical features and prognosis of gastric cancer-related microangiopathic hemolytic anemia in order to improve the recognition of the disease. Methods A case of gastric cancer-related microangiopathic hemolytic anemia was reported and the related domestic literatures were reviewed. Results We reviewed and analyzed 18 cases of gastric cancer-related microangiopathic hemolytic anemia, we reported 1 case and reviewed the other 17 cases.10 male（ 55.56% ）, 8 female（ 44.44% ）, the ratio was 1.13 ： 1, the median patient age was 41 years （ 23-68 ） , all were diagnosed as glandular cancer by gastroscopic biopsies, and 8 cases were metastatic carcinoma of bone manow. The clinical features were progressive anemia and soy urine, mostly with lymph node and other distant metastasis. The severalanemia and sehistocytes were described in all cases. These patients had short survival, the median survival time was 23 days. Conclusion Gastric cancer-related microangiopalhic hemolylic anemia was uncommon. with the following characteristics： the intravascular hemolytic anemia is not consistent with primary disease; metastasized widely; glandular cancer; several anemia. The prognosis is poor, the survival time is shorter; chemotherapy can improve the prognosis.