Thrombotic microangiopathy purpura in a patient with metastatic colorectal carcinoma

• Published in: Zdravniški vestnik (Ljubljana, Slovenia : 1992) Vol. 84; no. 7-8
• Main Authors: Tea Nizič-Kos, Samo Zver, Erik Brecelj
• Format: Journal Article
• Language: English
• Published: Slovenian Medical Association 01.09.2015
• Subjects: Key words: metastatic carcinoma, colorectal cancer, thrombotic microangiopathy, plasmapheresis, chemotherapy
• ISSN: 1318-0347

 Abstract Background: Thrombotic microangiopathy (TMA) is a rare syndrome that leads to excessive formation of blood clots, microthrombosis and is accompanied by non-autoimune haemolytic anemia and thrombocytopenia. Only few cases describing TMA caused by cancer are being reported in the literature. Patient: A 42-year old male patient with metastatic carcinoma of sigma and several accompanying diagnoses (pulmonary embolism, deep vein thrombosis, cerebrovascular insult) had later developed clinical and laboratory signs of TMA. TMA was unresponsive to plasmapheresis, which was discontinued and first cycle of chemotherapy was applied. The patient died soon after. The autopsy did not provide any additional information about the disease, there were no signs of malignant bone marrow infiltration. Conclusion: The diagnosis of secondary TMA remains a diagnostic and therapeutic challenge. It appears as a rare complication in patients with cancer. Treatment is difficult because the cause of TMA (malignancy) is hard to remove. Patients with cancer do not respond to plasmapheresis, which often delays the application of chemotherapy, the only effective treatment for TMA. Consequently this condition has poor prognosis.