[Microangiopathic hemolytic anemia associated with cancers. Symptomatic treatment by plasma exchange].
OBJECTIVE
To determine the interest of plasmapheresis in the management of cancer-associated microangiopathic haemolytic anaemia (MHA) not due to cancer treatment.


METHODS
[corrected] National retrospective study using the file of the French Hemapheresis Society.


RESULTS
We isolated 6 patients (5 men and a woman aged 32 to 69-year-old) who had prostatic (4 cases) or breast carcinomas or Hodgkin's disease. Diagnosis of cancer preceeded MHA in 3 patients (from 2 to 4 years). Bone or bone marrow metastases were demonstrated in 5 patients. The clinical presentation included anuria (4 cases), bleeding (4 cases), and laboratory findings were consistent with microangiopathic haemolysis and thrombopenia in all cases and intravascular coagulation (2 cases) and/or renal failure (4 cases). MHA symptomatic treatment included 4 to 10 courses of plasmapheresis, extra-renal epuration (4 patients), anticoagulation (4 patients) and/or antiagregant (3 cases), haemodialysis (4 cases) and vincristine (2 cases). Cancer treatment consisted of antitumoural chemotherapy (2 cases) and/or hormonotherapy (5 cases). In all cases, haemolysis, thrombopenia and intravascular coagulation were controlled within 30 days. MHA treatment was effective alone in 3 patients. No relapse were observed in 3 patients whereas the course of cancer continued in 2 patients. Two patients relapsed and died from MHA after 4 and 36 months. Two patients relapsed and died from MHA within a few months and 1 was lost to follow-up.


CONCLUSIONS
Symptomatic treatment of cancer-associated MHA including plasmapheresis may be useful while waiting for an aetiologic management of the tumour.
Généreau
T
T
Service de Médecine Interne, Hôpital Avicenne, Bobigny.
De Cagny
B
B
Branger
B
B
Chérin
P
P
Bentata
M
M
Brivet
F
F
Korach
J M
JM
Guillevin
L
L
D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology / Q000628:therapy*; D001859:Bone Neoplasms / Q000556:secondary / Q000628:therapy; D001943:Breast Neoplasms / Q000209:etiology / Q000628:therapy; D005260:Female; D006689:Hodgkin Disease / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010951:Plasma Exchange; D011471:Prostatic Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
Anémies hémolytiques micro-angiopathiques associées aux cancers. Traitement symptomatique par échanges plasmatiques.