LAUSR

Microangiopathic hemolytic anemia (MAHA) in breast cancer patients has been well described. Cancer-related MAHA (CR-MAHA) with thrombocytopenia is a thrombotic microangiopathy (TMA) syndrome defined by non-immune hemolytic anemia, low platelets, and microvascular thrombi resulting in end organ damage. CR-MAHA can occur as a result of the cancer itself or secondary to anti-neoplastic therapies. One of the earliest reports was of a woman with metastatic breast cancer who developed MAHA due to intravascular tumor microemboli 10 years after diagnosis. 1 Since then, much has been learned about MAHA in the setting of malignancy but further characterization of the natural history and biology is needed given the poor prognosis of patients with CR-MAHA, including those with breast cancer. 2 The unique pathophysi-ology of CR-MAHA can mimic thrombotic thrombocytopenic purpura (TTP), fulfilling all criteria of the PLASMIC score. Thus, when the PLASMIC score was developed, it excluded patients with active cancer within the preceding year.