Management of cancer‐associated thrombotic microangiopathy: What is the right approach?

Werner, Theresa L.; Agarwal, Neeraj; Carney, Heather; Rodgers, George M.

doi:10.1002/ajh.20783

Cited by 57 publications

(36 citation statements)

References 17 publications

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“…Nonconvulsive status epilepticus has been reported in TTP and may present as fluctuating stupor [44]. Treatment involves plasmapheresis; however, TTP associated with cancer is poorly responsive to treatment [45].…”

Section: Thrombotic Thrombocytopenic Purpuramentioning

confidence: 99%

Seizures and epilepsy in cancer: Etiologies, evaluation, and management

Grewal

Grewal²,

Forman³

2008

Curr Oncol Rep

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Seizure and epilepsy are common neurologic issues in cancer patients. Etiologies include structural abnormalities of the brain (eg, brain metastasis), cerebrovascular disease, reversible posterior leukoencephalopathy syndrome (RPLS), and radiation toxicity. Seizures associated with these etiologies often have focal features. Metabolic causes include hypoglycemia, electrolyte abnormalities, tumor lysis syndrome, thrombotic thrombocytopenic purpura (TTP), and medications used in cancer. A careful clinical evaluation can suggest the seizure etiology and guide subsequent work-up. Nonconvulsive status epilepticus should be suspected with persistent decreased level of consciousness following a seizure. Certain etiologies, such as RPLS and TTP, must be treated aggressively to minimize permanent neurologic injury. Routine prophylaxis with antiepileptic drugs (AEDs) is not recommended in patients with primary brain tumors or brain metastasis who have never had a seizure. Where indicated, the selection of AEDs should take into consideration side effects and interactions with chemotherapy. For this reason, non-enzyme-inducing AEDs are preferable in the cancer setting.

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Section: Thrombotic Thrombocytopenic Purpuramentioning

confidence: 99%

Seizures and epilepsy in cancer: Etiologies, evaluation, and management

Grewal

Grewal²,

Forman³

2008

Curr Oncol Rep

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“…TMAs are a heterogeneous group of disorders characterized by microvascular occlusion, resulting in thrombocytopenia, microangiopathic hemolytic anemia, and ischemic organ dysfunction [6]. The pathophysiology of cancer-associated TMA remains incompletely understood, but may involve the release of ultra-large von Willebrand factor multimers and/or an acquired deficiency of its cleaving metalloproteinase, ADAMTS13 [7].…”

Section: Discussionmentioning

confidence: 99%

Clinical Evidence that Coagulation Activation Drives Cancer Progression - a Report of 2 Cases

Voigtlaender

Holstein²,

Leuenroth³

et al. 2015

Oncol Res Treat

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Background: Tissue factor (TF), the principal initiator of the extrinsic coagulation pathway, is expressed by many tumors and can be released into the bloodstream on plasma microparticles (MPs). Experimental studies indicate that TF may facilitate hematogenous metastasis by promoting tumor cell-induced microvascular thrombosis, but clinical data supporting this hypothesis is sparse. Case Reports: Here, we report 2 unusual cases of rapidly progressive solid malignancies (gastric and urothelial carcinoma). In both patients, cancer cell dissemination with diffuse bone marrow involvement was either strongly suggested by leukoerythroblastic changes on peripheral blood smear or directly proven by positive findings on aspiration cytology. Furthermore, laboratory evidence of thrombotic microangiopathy (TMA) and disseminated intravascular coagulation was accompanied by new-onset severe pulmonary hypertension and a hemolytic uremic syndrome-like disorder in the gastric and the urothelial carcinoma patient, respectively. TF-specific procoagulant activity of isolated plasma MPs, as assessed by single-stage clotting assay, was dramatically increased in both patients compared to healthy controls (21- and 55-fold), and primary tumor samples stained strongly positive for TF by immunohistochemistry. Conclusion: TMA was likely caused by TF-triggered tumor cell embolization in both patients. Further clinical evidence is thus provided that TF directly links coagulation activation to cancer cell dissemination.

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“…We did not look immediately for a deficiency of ADAMTS-13. The laboratory is testing now ADAMTS13 activity, but as we know through the literature, it will probably result not informative (9,10).…”

Section: Discussionmentioning

confidence: 99%

Oxaliplatin-Induced Haemolytic Anaemia: A Case Report

Compostella

Ghiotto

et al. 2007

Clinical medicine. Oncology

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Oxaliplatin plus 5Fluorouracil (5FU) and leucovorin (LV) is the standard treatment of metastatic colorectal cancer (CRC). We describe a rare clinical case of acute renal failure probably oxaliplatin-related at one day from the end of the palliative treatment. A 36 year-old woman developed a stage I CRC. Five months later a liver lesion was detected and treated with FOLFOX4 schedule. Because of progression the patient underwent surgery and she repeated the Oxaliplatin-based therapy for more than one cycle. After many months of therapy, on the second day, the patient noticed urine discoloration. Immediate urinanalysis demonstrated haemoglobinuria. The patient's complete blood count exhibited signs consistent with acute hemolysis, neutrophilic leucocytosis, thrombocytopenia and acute renal failure. She was treated with blood transfusion and hemodialysis and she was managed conservatively with monitored intravenous hydration and loop diuretics. The patient gradually recovered and the results of successive hematological and biochemical tests confi rmed the improvement of her condition but a cardiologic evaluation showed a iatrogenic depressed systolic function (ejection fraction of 40%).

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Management of cancer‐associated thrombotic microangiopathy: What is the right approach?

Cited by 57 publications

References 17 publications

Seizures and epilepsy in cancer: Etiologies, evaluation, and management

Seizures and epilepsy in cancer: Etiologies, evaluation, and management

Clinical Evidence that Coagulation Activation Drives Cancer Progression - a Report of 2 Cases

Oxaliplatin-Induced Haemolytic Anaemia: A Case Report

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