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How I treat microangiopathic hemolytic anemia in patients with cancer

Microangiopathic hemolytic anemia (MAHA) with thrombocytopenia, suggests a thrombotic microangiopathy (TMA), linked with thrombus formation affecting small or larger vessels. In cancer patients, it may be directly related to the underlying malignancy (initial presentation or progressive disease), to...

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Autores principales: Thomas, M. R., Scully, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555418/
https://www.ncbi.nlm.nih.gov/pubmed/33512445
http://dx.doi.org/10.1182/blood.2019003810
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author Thomas, M. R.
Scully, M.
author_facet Thomas, M. R.
Scully, M.
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description Microangiopathic hemolytic anemia (MAHA) with thrombocytopenia, suggests a thrombotic microangiopathy (TMA), linked with thrombus formation affecting small or larger vessels. In cancer patients, it may be directly related to the underlying malignancy (initial presentation or progressive disease), to its treatment, or a separate incidental diagnosis. It is vital to differentiate incidental thrombotic thrombocytopenia purpura or atypical hemolytic uremic syndrome in cancer patients presenting with a TMA, as they have different treatment strategies, and prompt initiation of treatment impacts outcome. In the oncology patient, widespread microvascular metastases or extensive bone marrow involvement can cause MAHA and thrombocytopenia. A disseminated intravascular coagulation (DIC) picture may be precipitated by sepsis or driven by the cancer itself. Cancer therapies may cause a TMA, either dose-dependent toxicity, or an idiosyncratic immune-mediated reaction due to drug-dependent antibodies. Many causes of TMA seen in the oncology patient do not respond to plasma exchange and, where feasible, treatment of the underlying malignancy is important in controlling both cancer-TMA or DIC driven disease. Drug-induced TMA should be considered and any putative causal agent stopped. We will discuss the differential diagnosis and treatment of MAHA in patients with cancer using clinical cases to highlight management principles.
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spelling pubmed-85554182022-03-11 How I treat microangiopathic hemolytic anemia in patients with cancer Thomas, M. R. Scully, M. Blood How I Treat Series Microangiopathic hemolytic anemia (MAHA) with thrombocytopenia, suggests a thrombotic microangiopathy (TMA), linked with thrombus formation affecting small or larger vessels. In cancer patients, it may be directly related to the underlying malignancy (initial presentation or progressive disease), to its treatment, or a separate incidental diagnosis. It is vital to differentiate incidental thrombotic thrombocytopenia purpura or atypical hemolytic uremic syndrome in cancer patients presenting with a TMA, as they have different treatment strategies, and prompt initiation of treatment impacts outcome. In the oncology patient, widespread microvascular metastases or extensive bone marrow involvement can cause MAHA and thrombocytopenia. A disseminated intravascular coagulation (DIC) picture may be precipitated by sepsis or driven by the cancer itself. Cancer therapies may cause a TMA, either dose-dependent toxicity, or an idiosyncratic immune-mediated reaction due to drug-dependent antibodies. Many causes of TMA seen in the oncology patient do not respond to plasma exchange and, where feasible, treatment of the underlying malignancy is important in controlling both cancer-TMA or DIC driven disease. Drug-induced TMA should be considered and any putative causal agent stopped. We will discuss the differential diagnosis and treatment of MAHA in patients with cancer using clinical cases to highlight management principles. American Society of Hematology 2021-03-11 /pmc/articles/PMC8555418/ /pubmed/33512445 http://dx.doi.org/10.1182/blood.2019003810 Text en © 2021 by The American Society of Hematology This article is made available via the PMC Open Access Subset for unrestricted reuse and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle How I Treat Series
Thomas, M. R.
Scully, M.
How I treat microangiopathic hemolytic anemia in patients with cancer
title How I treat microangiopathic hemolytic anemia in patients with cancer
title_full How I treat microangiopathic hemolytic anemia in patients with cancer
title_fullStr How I treat microangiopathic hemolytic anemia in patients with cancer
title_full_unstemmed How I treat microangiopathic hemolytic anemia in patients with cancer
title_short How I treat microangiopathic hemolytic anemia in patients with cancer
title_sort how i treat microangiopathic hemolytic anemia in patients with cancer
topic How I Treat Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555418/
https://www.ncbi.nlm.nih.gov/pubmed/33512445
http://dx.doi.org/10.1182/blood.2019003810
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