A Case of Paroxysmal Nocturnal Hemoglabinuria(PNH) - Like Secondary Myelofibrosis with Gastric Cancer

A case of PNH-like secondary myelofibrosis associated gastric cancer is presented with brief literal view. This 45 years old Korean male who had gastric cancer, was admitted to Ewha University hospital with marked pallor and bone pain. On hematologic examination, hemoglobin 4.0 gm/dl, hematocrit 8%, and RBC count was 92×10⁴/mm³. WBC count was 16,200/mm³, with normal differentiation and platelet count was 18,000/mm³. Reticulocyte count was 5%. Peripheral blood smear showed anisocytosis, poikilocytosis and schistocytes including tear-drop cell. Two attempts of bone marrow biopsy disclosed island-shape of gastric cancer call infiltration and reticulin strands. After transfusion with 4 units of whole blood over the night, his early morning urine color was dark reddish-brown. The HAM test was positive and the value of the leukocyte alkaline phosphatase was very high. But there was no specific change of urine after administration of Iron-dextran. The author assure that this case was accompanied by Paroxysmal Nocturnal Hemoglobinuria-like red cell defect rather than microangiopathic hemolytic anemia.