Korean J Gastroenterol.  2025 Jan;85(1):73-77. 10.4166/kjg.2024.110.

Microangiopathic Hemolytic Anemia: A Rare Complication of Acute Pancreatitis

• Ayesha S
• Karim MM
• Ali M
• Shahid AH
• Adil SN

• KMID: 2565017
• DOI: http://doi.org/10.4166/kjg.2024.110

Abstract

Microangiopathic hemolytic anemia (MAHA) is a rare subtype of hemolytic anemia characterized by elevated hemolytic markers and red blood cell destruction. Though uncommon, MAHA can occur as a complication of acute pancreatitis because of the associated inflammatory response. Patients with MAHA secondary to pancreatitis show favorable outcomes when treated with plasma exchange. This paper presents the case of a patient diagnosed with acute pancreatitis-induced hemolytic anemia and thrombocytopenia, who was managed successfully with plasma exchange, steroids, and rituximab. Clinicians should maintain a high index of suspicion in patients with acute pancreatitis who present with anemia, thrombocytopenia, and schistocytes on peripheral smears, even in the absence of end-organ injuries and with normal ADAMTS13 activity. The early initiation of plasmapheresis can be lifesaving. The timely introduction of rituximab in cases where plasma exchange and steroids are insufficient, despite the ADAMTS13 activity status, may lead to better outcomes.

Keyword

Pancreatitis; Microangiopathic hemolytic anemia; Thrombocytopenia; Plasmapheresis; Rituximab

Figure

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  Fig. 1 (A) Computed tomography CT scan abdomen axial view–Minimal fat fuzziness is seen in the pancreatic location with peri-pancreatic fat stranding (red arrow) and mild thickening of the Gerota’s fascia bilaterally (blue arrow). These findings are consistent with acute pancreatitis. (B) CT scan abdomen sagittal view–Showing blurring of the outline of pancreatic clefts (red arrows). Mild thickening of the Gerota’s fascia bilaterally (blue arrow). These findings are also consistent with acute pancreatitis.

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  Fig. 2 (A) Bone marrow aspirate (normal) - Neutrophil (blue arrow) - Erythroblast (black arrow) - Basophilic Erythroblast (red arrow). (B) Trephine biopsy (normal) showing no evidence of bone marrow infiltration - Fat cells (blue arrow) - Megakaryocytes (red arrow).

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  Fig. 3 (A) Clustered bar graph illustrating the timing of the changes in the treatment strategy and the duration of each treatment in relation to trends in hemoglobin levels, fragmented RBC counts, platelet counts, and LDH levels. The colored dotted lines indicate the duration of each specific treatment. (B) Double-line graph depicting the timing of treatment adjustments and the duration of each therapy in relation to trends in platelet counts and LDH levels. Each specific treatment is represented by a distinct colored dotted line indicating its duration. (C) Double-line graph depicting the timing of treatment adjustments and the duration of each therapy in relation to the trends in hemoglobin levels and fragmented RBC counts. Each specific treatment is represented by a distinct colored dotted line indicating its duration. RBCs, red blood cells; LDH, lactate dehydrogenase.

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