Glucocorticoid-induced thrombotic microangiopathy in paroxysmal nocturnal hemoglobinuria: A case report and review of literature

Figure 1 Morphological examination of marrow and blood smears. A: Morphological examination of the marrow smears showed significantly increased cellularity with an increased percentage of erythroid progenitors in the absence of evident dysplasia. The number of megakaryocytes was within the normal level without immature and dysplastic features; B: Morphological examination of the blood smears revealed the presence of a small number of schistocytes (orange arrows), dacryocytes (yellow arrows), acanthocytes (purple arrows) and target cells (blue arrows), confirming the existence of microangiopathic hemolysis. Platelets were rarely visualized.

Figure 2 Sequential hematological changes following initiation and discontinuation of glucocorticoid treatment. Following initiation of methylprednisolone treatment, the hemoglobin levels (Hb ×10 g/L) and platelet counts (Plt × 10 × 10⁹/L) rapidly decreased, together with a decrease in white blood cells (WBC ×10⁹/L) and an increase in absolute reticulocyte count (Ret × 10 × 10⁹/L). Increasing the methylprednisolone dose after hospitalization resulted in the worsening of platelet consumption and intravenous hemolysis. Discontinuation of methylprednisolone treatment showed significant hematological improvement with restoration of hemoglobin levels and platelet counts similar to those prior to methylprednisolone treatment.