Microangiopathic hemolytic anemia, thrombocytopenia, and renal failure in patients treated for adenocarcinoma

Abstract

Microangiopathic hemolytic anemia and thrombocytopenia secondary to disseminated intravascular coagulation is a well-described complication of widely metastatic carcinoma. The authors report four cases of gastric carcinoma, one case of colon cancer, and one case of adenocarcinoma of unknown primary in which the patient developed a syndrome analagous to thrombotic thrombocytopenic purpura, consisting of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure without definite evidence of disseminated intravascular coagulation. In contrast to previous reports, postmortem examination in three of the cases revealed no recurrence or only microscopic foci of residual tumor. In the remaining three, there was clinical and pathologic evidence of grossly disseminated carcinoma. Also in contrast to previous cases, all patients evidenced azotemia and proteinuria at the onset of the syndrome and ultimately uremia was a contributing cause of death. Coagulation profiles showed prolonged thrombin times and elevated fibrin degradation products in four instances and did not distinguish the patients with grossly metastatic disease from those with no tumor or only microscopic residua. Circulating immune complexes containing carcinoembryonic antigen were found in the patient with metastatic colon carcinoma. The syndrohe was clinically identical whether or not grossly metastatic tumor was present, and it should not be attributed to advanced disease without definite clinical or pathologic evidence of a recurrence. Cancer 48:1738-1745. 1981. I(ROAN(iIOPA1 H I (H t M O L Y I I (A N t : M I A iS a M w el I-d oc 11 me n t e d co m p I ic a t i on of met as t a t i c carcinoma.'.2 The anemia is thought to be caused by a fragmentation of erythrocytes on fibrin strands that From the * H em at o I og y-0 n c o I og y. W a I t e r Reed Arm y Medical C e nt e r ,

Thrombotic Thrombocytopenic Purpura Associated with Bone Marrow Metastasis and Secondary Myelofibrosis in Cancer

“…In patients with cancer, various cancer chemotherapeutic agents have been implicated; mitomycin C [6,[25][26] has been most commonly associated with both TTP and hemolytic uremic syndrome, and other agents, including cisplatin [27], deoxycoformycin [28], the regimen of cisplatin, bleomycin, and a vinca alkaloid [29], the combination of daunorubicin and cytosine arabinoside [30], and combination regimens containing cisplatin [31], have also been implicated. In addition, cancer itself has been suspected to cause TTP [22][23][24], but neither a clear link between cancer and the development of TTP nor a risk factor for TTP in cancer patients has been identified. We attempted to address this issue by reviewing all the known cases of TTP in patients with active cancer in our institution for a period of more than 20 years.…”

“…In addition, the term thrombotic microangiopathy (TM) has been introduced to include hemolytic uremic syndrome, hemolysis with elevated liver enzyme levels and a low platelet count (HELLP) syndrome, and dyadic TTP in addition to classical TTP. Secondary TM has been known to be associated with collagen vascular diseases [2][3][4][5], use of certain drugs [6][7][8][9], transplants [10][11][12][13], surgeries [14][15][16][17], infections [18,19], pregnancy [20,21], and cancer [22][23][24]. In cancer patients, at least two causes for TM have been identified.…”

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

“…Most cases of cancer-associated TMA have been reported in patients with mucin producing adenocarcinomas, predominantly gastric and breast cancer [14]. In addition to being reported in patients with widely disseminated malignancies [15], the process of TMA has also been described in cases of isolated invasion of the bone marrow by the tumor [16].…”

Thrombotic Microangiopathy and Occult Neoplasia

“…Malignancy-associated TMA is mainly observed in adults and is encountered in a wide variety of tumours, with adenocarcinomas of the stomach, breast and lung being the most common [30,31].…”