Case 26-1984

Cabot, Richard C.; Scully, Robert E.; McNeely, Betty U.; Canellos, George P.; Mark, Eugene J.

doi:10.1056/nejm198406283102608

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…CR-MAHA is distinguished from primary TMA in terms of its underlying disorders and treatment options. CR-MAHA has been reported in association with several types of carcinoma since the 1980s (Pendse et al 2014 ; Lechner and Obermeier 2012 ; Shin et al 2011 ; Rauh et al 2011 ; George 2011 ; Himmelmann and Schefer 2009 ; Ali et al 2007 ; Arkenau et al 2005 ; Yeh et al 2002 ; Lockhart 2001 ; Fontana et al 2001 ; Ataga and Graham 1999 ; Narita et al 1997 ; Tsatsaris et al 1996 ; Nordstrom and Strang 1993 ; Bastecky et al 1992 ; Collins et al 1991 ; Canellos and Mark 1984 ). Lechner,K et al conducted a literature review of 168 reports of CR-MAHA; according to cancer type, gastric cancer was the most frequent, followed by breast, prostate, and lung cancers.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…The reported age of onset ranges from 19 to 82 years, suggesting that onset can occur at any age (Pendse et al 2014 ; Lechner and Obermeier 2012 ; George 2011 ; Himmelmann and Schefer 2009 ; Lockhart 2001 ; Fontana et al 2001 ; Ataga and Graham 1999 ; Narita et al 1997 ; Nordstrom and Strang 1993 ; Bastecky et al 1992 ; Collins et al 1991 ; Canellos and Mark 1984 ; Brain et al 1962 ). CR-MAHA is rare, and detailed reports on its incidence according to cancer type are not available.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Very little is known about the pathophysiology of CR-MAHA; microvascular thrombi of carcinoma cells were found in multiple organs in many autopsy cases. The mechanism by which hemolysis progresses due to the mechanical fragmentation of red blood cells as blood flows through the vascular lumen narrowed by such tumor thrombi has been proposed (Lockhart 2001 ; Canellos and Mark 1984 ; Stephens 2011 ). Accordingly, rationale for the use of antineoplastic agents is supported, as an effort to reduce tumor burden is considered most important in improving MAHA.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…MAHA is reportedly associated with TTP and HUS, with very similar pathological states for both; however, CR-MAHA is believed to have a different pathogenic mechanism (Lechner and Obermeier 2012 ; Lockhart 2001 ; Nordstrom and Strang 1993 ; Canellos and Mark 1984 ).…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Its occurrence in cases of widespread metastasis of malignant tumors [cancer-related MAHA (CR-MAHA)] has also been reported, albeit rarely (Pendse et al 2014 ; Lechner and Obermeier 2012 ; Shin et al 2011 ; Rauh et al 2011 ; George 2011 ; Himmelmann and Schefer 2009 ; Ali et al 2007 ; Arkenau et al 2005 ; Yeh et al 2002 ; Lockhart 2001 ; Fontana et al 2001 ; Ataga and Graham 1999 ; Narita et al 1997 ; Tsatsaris et al 1996 ; Nordstrom and Strang 1993 ; Bastecky et al 1992 ; Collins et al 1991 ; Canellos and Mark 1984 ). CR-MAHA has been reported in several types of carcinoma (Pendse et al 2014 ; Lechner and Obermeier 2012 ; Shin et al 2011 ; Rauh et al 2011 ; George 2011 ; Himmelmann and Schefer 2009 ; Ali et al 2007 ; Arkenau et al 2005 ; Yeh et al 2002 ; Lockhart 2001 ; Fontana et al 2001 ; Ataga and Graham 1999 ; Narita et al 1997 ; Tsatsaris et al 1996 ; Nordstrom and Strang 1993 ; Bastecky et al 1992 ; Collins et al 1991 ; Canellos and Mark 1984 ), but its pathophysiology remains largely unknown and there is no established management method. In general, its prognosis is said to be very poor, but many reports indicate that the patients respond to drug therapy (Lechner and Obermeier 2012 ; Lockhart 2001 ; Fontana et al 2001 ; Narita et al 1997 ; Nordstrom and Strang 1993 ; Collins et al 1991 ).…”

Section: Introductionmentioning

confidence: 99%

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Microangiopathic hemolytic anemia associated with metastatic breast cancer: case report and literature review

Takabatake¹,

Oishi²

2016

SpringerPlus

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IntroductionMicroangiopathic hemolytic anemia (MAHA) is a mechanical hemolytic anemia characterized by the emergence of fragmented red cells in peripheral blood. Here, we report a case of breast cancer associated with cancer-related (CR)-MAHA along with a literature review.Case descriptionThe patient was a 54-year-old woman who made an emergency visit to our hospital because of low back pain, shoulder pain, visual impairment, and anemia. She was diagnosed with stage IV, ER-positive, PgR-positive, HER2-negative left breast cancer (invasive lobular carcinoma), with left axillary adenopathy, metastasis to the soft tissue of the orbital region, multiple bone metastases, pleural dissemination, and metastasis to the stomach and para-aortic lymph nodes. Chemotherapy was initiated successfully; tumor marker levels normalized and the visceral metastases almost disappeared. Hormone therapy was administered for maintenance. Two and a half years later, rapid elevation in tumor marker levels and severe anemia were noted, and fragmented red cells and poikilocytes emerged in the peripheral blood. Positron emission tomography–computed tomography and bone scintigraphy revealed multiple bone metastases, but no evidence of visceral metastasis. CR-MAHA associated with multiple bone metastases was diagnosed, and Paclitaxel chemotherapy was initiated with frequent blood transfusions. Her anemia gradually improved, with a decrease in tumor marker levels and the number of blood transfusions. Three months later, tumor marker levels increased again. Because the anemia was also exacerbated, chemotherapy was changed to eribulin. Tumor marker levels temporally decreased, and the anemia tended to improve, but 3 months later, the levels were elevated again and the anemia was exacerbated. A switch to another regimen was planned, but best supportive care was chosen instead because of rapid deterioration of liver function. The patient died a month later.Discussion and evaluationCR-MAHA is thought to have a different pathologic mechanism from TTP or HUS. Although CR-MAHA is a clinical condition associated with a very poor prognosis, we consider it controllable for long period by rapid introduction of chemotherapy in many cases.ConclusionsCR-MAHA is a nearly oncologic emergency that medical oncologists need to be able to recognize even though it rarely occurs in breast cancer.

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