Successful treatment with continuous high-dose 5-fluorouracil infusion, followed by oral capecitabine in a patient with advanced gastric cancer with bone marrow metastasis and microangiopathic hemolytic anemia

A 61-year-old male with a history of Stage 1A gastric body adenocarcinoma and s/p radical subtotal gastrectomy + B-II reconstruction 5 years previously presented with general malaise and bone pain. A hemogram revealed severe anemia and thrombocytopenia, which were refractory to blood transfusion. A peripheral blood smear showed marked thrombocytopenia with numerous fragmented red blood cells and normoblasts. A bone marrow biopsy showed metastatic adenocarcinoma of gastric origin. Therefore, he was diagnosed with cancer-associated microangiopathic hemolytic anemia (MAHA). In addition to aggressive transfusion support, high-dose continuous 5-fluorouracil infusion was administered, and the MAHA and thrombocytopenia dramatically resolved. Capecitabine was subsequently administered orally at the outpatient clinic, and his disease was well controlled without the recurrence of MAHA or thrombocytopenia for 1 year. Although most chemotherapies may aggravate cytopenia, our case illustrates that effective chemotherapy can not only control cancer-associated MAHA but also restore cytopenia to normal.