Microangiopathic hemolytic anemia (MAHA) is a rare paraneoplastic syndrome that can be an initial manifestation of advanced malignancy. This report presents the case of a 54-year-old male with symptoms of fatigue and anemia, later diagnosed with gastric signet ring cell carcinoma and bone marrow infiltration. Despite initial management with plasmapheresis and immunosuppressive therapy, the patient’s condition deteriorated, highlighting the limited efficacy of these interventions in cancer-associated MAHA. The case underscores the importance of recognizing MAHA as a potential paraneoplastic syndrome, emphasizing timely diagnosis and appropriate oncological treatment to improve outcomes. Unfortunately, the prognosis remains poor in advanced disease with bone marrow involvement.
