Microangiopathic hemolytic anemia in a patient with recurrent anal cancer and liver metastasis

Microangiopathic hemolytic anemia (MAHA) is a late but fatal complication in advanced cancers (cancer-associated). It may also appear in complete remission after chemotherapy (chemotherapy-related). Mucin-producing adenocarcinoma has been extensively studied in relation to this phenomenon. Squamous cell carcinoma with MAHA, on the other hand, has not often been reported in the English literature. Because of the difficulty of case collection, understanding of the association of MAHA and anal squamous cell carcinoma remains vague. We present a 60-year-old woman with anal cancer and liver metastasis. This patient received chemotherapy (mitomycin C, 5-fluoruracil, and cisplatin) and reached a good partial response. MAHA developed 2 months later, and tumor recurrence with rapid deterioration appeared 5 months later. The patient died 5 months after MAHA was diagnosed. We consider that the MAHA in this patient is chemotherapy-related. However, the possibility of cancer-associated MAHA could not be excluded.