Transitional cell carcinoma of the bladder metastatic to bone marrow presenting as isolated anaemia and thrombocytopenia

Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report. We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases. There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests. Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment.