Management of cancer-associated thrombotic microangiopathy: what is the right approach?
A 49-year-old Caucasian woman presented with features suggestive of thrombotic microangiopathy (TMA). She did not respond to treatment with repeated plasma exchange and corticosteroids. A bone marrow biopsy revealed presence of metastatic carcinoma. A limited autopsy revealed presence of breast cancer with rib metastases. Though severe deficiency of von Willebrand factor-cleaving protease was initially proposed as a key pathogenetic factor for thrombotic thrombocytopenic purpura, subsequent studies involving patients with cancer-associated TMA did not find as severe a deficiency of von Willebrand factor-cleaving protease as is seen in idiopathic cases of thrombotic thrombocytopenic purpura. Here we address one approach of management of these patients with cancer-associated TMA.
Werner
Theresa L
TL
Division of Hematology, University of Utah Hospitals and Clinics, Salt Lake City, Utah, USA.
Agarwal
Neeraj
N
Carney
Heather M
HM
Rodgers
George M
GM
D000743:Anemia, Hemolytic / Q000209:etiology* / Q000628:therapy; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary*; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology*; D018394:CA-125 Antigen / Q000097:blood; D018275:Carcinoma, Lobular / Q000150:complications / Q000556:secondary*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010951:Plasma Exchange; D013921:Thrombocytopenia / Q000209:etiology* / Q000628:therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy
D018394:CA-125 Antigen