A Rare Association of Autoimmune Hemolytic Anemia withGastric Adenocarcinoma

An 80-year-old male presented with dyspnea on exertion for at least two months. He also complained of progressive dysphagia andweight loss of 35 pounds over the last eight months. Initial blood tests showed hemoglobin of 6.1 g/dl, reticulocytes count of 19.7%,total bilirubin of 3.2 mg/dl, lactate dehydrogenase of 600 U/L, and haptoglobin of less than 8 mg/dl, and direct Coombs test waspositive for warm immunoglobulin G. The impression was autoimmune hemolytic anemia (AIHA). The evaluation of dysphagiawith esophagogastroduodenoscopy revealed a single irregular 4 cm malignant appearing ulcerated mass at the incisura angularis ofthe stomach. The mass was confirmed as adenocarcinoma on biopsy. Diagnostic laparoscopy was positive for malignant cells andhe was diagnosed with stage IV adenocarcinoma of the stomach. Other extensive workup to determine the etiology of AIHA wasnegative (described in detail below). Surgery was deferred primarily due to metastasis of cancer. Initially, hemoglobin was stabilizedby intravenous methylprednisolone, high dose immunoglobulins, and packed red blood cell transfusions. After a few weeks,hemoglobin started trending down again. The patient was weaned off steroids and paradoxically IgG-mediated autohemolysis wascontrolled with the initiation of palliative chemotherapy. Our case highlights a rare occurrence of AIHA in association with gastricadenocarcinoma