Management of cancer-associated thrombotic microangiopathy: what is the right approach?

Am J Hematol. 2007 Apr;82(4):295-8. doi: 10.1002/ajh.20783.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anemia, Hemolytic / etiology*
  • Anemia, Hemolytic / therapy
  • Bone Neoplasms / complications
  • Bone Neoplasms / secondary*
  • Breast Neoplasms / complications
  • Breast Neoplasms / pathology*
  • CA-125 Antigen / blood
  • Carcinoma, Lobular / complications
  • Carcinoma, Lobular / secondary*
  • Female
  • Humans
  • Middle Aged
  • Plasma Exchange*
  • Thrombocytopenia / etiology*
  • Thrombocytopenia / therapy
  • Thrombosis / etiology
  • Thrombosis / therapy


  • CA-125 Antigen