Hemolytic Anemia of Malignancy: A Case Study Involving Signet Ring Cell Metastatic Breast Cancer with Severe Microangiopathic Hemolytic Anemia

Lee, Eric H.; Otoukesh, Salman; Pour, Amir Abdi; Nagaraj, Gayathri

doi:10.1159/000494753

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…It should be noted that our patient presented with a lesser common malignancyassociated TMA, and had a colloid (i.e. mucin-producing) adenocarcinoma of the breast, which has been reported sparsely in the literature (10)(11). Further characteristics of cancer-associated TMA are listed in Table I.…”

Section: Discussionmentioning

confidence: 88%

“…However, some patients deteriorate quickly, precluding patients from receiving appropriate treatment on time. Cancer-related TMA has a high mortality rate (50%), making early identification and treatment essential to improving survival (11). Therapies, including plasma exchange and eculizumab, have been proposed for the treatment of cancer related TMA, with no proven efficacy.…”

Section: Discussionmentioning

confidence: 99%

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Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide

Jalali

Jenneman

Tandon

et al. 2021

In Vivo

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Background: Thrombotic microangiopathy (TMA) is a clinical syndrome consisting of hemolytic anemia, thrombocytopenia, and presence of schistocytes on peripheral blood smear secondary to disorders of systemic microvascular thrombosis. Malignancy-associated TMA is a rare entity and shares clinical features with that of HUS and TTP usually seen in patients with metastatic cancer, tumor cell infiltration of the bone marrow and/or response to cancer-directed therapy. Case Report: We present a rare case of TMA secondary to breast cancer without evidence of bone marrow infiltration responsive to doxorubicin and cyclophosphamide treatment, after failed plasmapheresis with prednisone and later, eculizumab. Conclusion: Despite being a rare manifestation of metastatic carcinoma, early identification and treatment are essential to improving survival.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide

Jalali

Jenneman

Tandon

et al. 2021

In Vivo

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“…Another mechanism is that there is red cell fragmentation from direct contact of erythrocytes with tumour emboli. However, both these theories are more suitable in metastatic cancer [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Post-partum occurrence of Wunderlich syndrome and microangiopathic haemolytic anaemia (MAHA): a case report

Swaminathan

Sedhom

Shahzad

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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This is a case of a 27-year-old primigravida with monochorionic diamniotic twin gestation who was admitted to the hospital for induction of labour. Her postpartum course was complicated by microangiopathic haemolytic anemia (MAHA). The etiology for the MAHA was initially thought to be secondary to pre-eclampsia and vitamin B12/folate deficiency. However, she had persistent anemia and further workup demonstrated that she had a left renal cell carcinoma (RCC) with perinephric haemorrhage consistent with Wunderlich syndrome. This case was intriguing because of its unusual presentation and the several diagnostic and therapeutic challenges along the way.

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“…The pathophysiology behind MAHA in malignancy is yet not well-understood, even if it is thought to be rather a paraneoplastic syndrome than an independent condition co-existing with cancer disease. Two mechanisms have been proposed: red cell fragmentation against tumor emboli within blood vessels and an increased vWF multimers release from bone marrow (the latter in response to altered angiogenesis and secondary myelofibrosis) ( 12 ). Cancer-related microangiopathic hemolytic anemia must not be confused with chemotherapy-induced MAHA, which is a specific form of drug-induced TMA, particularly frequent when using gemcitabine and mitomycin, and can be both immune and non-immune mediated.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Case Report: Microangiopathic Hemolytic Anemia With Normal ADAMTS13 Activity

et al. 2021

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Thrombotic microangiopathies (TMAs) include a heterogeneous group of diseases characterized by abnormalities in the vessel walls of arterioles and capillaries resulting in microvascular thrombosis that typically presents with a microangiopathic hemolytic anemia (MAHA) and severe thrombocytopenia. We describe here the case of an 82-year-old woman, who came to our attention for a clinical condition consistent with thrombotic microangiopathy. Even if initially highly suggestive for a thrombotic thrombocytopenic purpura (TTP), the elevated ADAMTS13 activity together with the alteration of the main coagulation parameters (D-dimer elevation, fibrinogen consumption, slightly prolonged prothrombin time), induced us to consider several other diseases in the differential diagnostic process. The case evolved toward a suspected overlapped secondary hemophagocytic syndrome, though the hyperferritinemia was finally interpreted within the frame of a cytokine storm. After a complex diagnostic workup, the clinical and biochemical parameters guided us toward the diagnosis of a cancer-related microangiopathic hemolytic anemia (CR-MAHA) secondary to a relapsing breast cancer with multiple metastatic localizations. Prednisone 1 mg/kg body weight was started, and several units of fresh frozen plasma were infused, obtaining a good control of the hemolysis. No specific oncological therapies were, however, possible, due to the older age and the critically compromised general condition of the patient; therefore, after clinical stabilization, the patient was discharged for treatment in a palliative care Hospital.

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Hemolytic Anemia of Malignancy: A Case Study Involving Signet Ring Cell Metastatic Breast Cancer with Severe Microangiopathic Hemolytic Anemia

Cited by 8 publications

References 14 publications

Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide

Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide

Post-partum occurrence of Wunderlich syndrome and microangiopathic haemolytic anaemia (MAHA): a case report

Case Report: Microangiopathic Hemolytic Anemia With Normal ADAMTS13 Activity

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