Abstract

Case Report

Prostate cancer-associated thrombotic microangiopathy: A case report and review of the literature

HHS Kharagjitsing*, PAW te Boekhorst and Nazik Durdu-Rayman

Published: 08 March, 2021 | Volume 5 - Issue 1 | Pages: 017-022

Background: Thrombotic microangiopathy (TMA) is a rare and life-threatening complication of prostate carcinoma. Whether plasma exchange has a role in treatment remains a subject of debate. Here we present a case followed by a systematic review of the literature on this subject.

Case report: We describe a 69-year old patient presenting with TMA, which was associated with an underlying metastatic prostate carcinoma. We conducted a search of similar cases in literature.

Results: Our patient was treated and responded well on plasma exchange. Systematic review of the literature showed 17 additional cases of TMA associated with prostate carcinoma of which eleven were treated with plasma exchange with mostly good response.

Conclusion: Based on current data we cannot exclude a potential role for plasma exchange in prostate cancer associated TMA.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001068 Cite this Article Read Full Article PDF

Keywords:

Thrombocytopenic purpura-haemolytic uremic syndrome; Prostate carcinoma Thrombotic microangiopathy; Plasma exchange

References

  1. George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med. 2014; 371: 654-666. PubMed: https://pubmed.ncbi.nlm.nih.gov/25119611/
  2. George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med. 2006; 354: 1927-1935. PubMed: https://pubmed.ncbi.nlm.nih.gov/16672704/
  3. Tsai HM, Lian EC. Antibodies to von Willebrand factor-cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med. 1998; 339: 1585-1594. PubMed: https://pubmed.ncbi.nlm.nih.gov/9828246/
  4. George JN. Tibor Greenwalt Award. The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome Registry: a program for patient care, education and research. Transfusion. 2004; 44: 1384-1392. PubMed: https://pubmed.ncbi.nlm.nih.gov/15318866/
  5. Lechner K, Obermeier HL. Cancer-related microangiopathic hemolytic anemia: clinical and laboratory features in 168 reported cases. Medicine. 2012; 91: 195-205. PubMed: https://pubmed.ncbi.nlm.nih.gov/22732949/
  6. von Bubnoff N, Sandherr M, Schneller F, Peschel C. Thrombotic thrombocytopenic purpura in metastatic carcinoma of the breast. Am J Clin Oncol. 2000; 23: 74-77. PubMed: https://pubmed.ncbi.nlm.nih.gov/10683084/
  7. Brain MC, Dacie JV, Hourihane DO. Microangiopathic haemolytic anaemia: the possible role of vascular lesions in pathogenesis. Br J Haematol. 1962; 8: 358-374. PubMed: https://pubmed.ncbi.nlm.nih.gov/14014893/
  8. Antman KH, Skarin AT, Mayer RJ, Hargreaves HK, Canellos GP. Microangiopathic hemolytic anemia and cancer: a review. Medicine. 1979; 58: 377-384. PubMed: https://pubmed.ncbi.nlm.nih.gov/481196/
  9. Chalasani P, Segar JM, Marron M, Stopeck A. Pathophysiology of tumour-induced microangiopathic haemolytic anaemia. BMJ Case Rep. 2016; 2016: bcr2015213521. PubMed: https://pubmed.ncbi.nlm.nih.gov/26744538/
  10. Contrino J, Hair G, Kreutzer DL, Rickles FR. In situ detection of tissue factor in vascular endothelial cells: correlation with the malignant phenotype of human breast disease. Nat Med. 1996; 2: 209-215. PubMed: https://pubmed.ncbi.nlm.nih.gov/8574967/
  11. Levi M. Cancer and DIC. Haemostasis. 2001; 31 Suppl 1: 47-48. PubMed: https://pubmed.ncbi.nlm.nih.gov/11990477/
  12. Brain MC, Azzopardi JG, Baker LR, Pineo GF, Roberts PD, Dacie JV. Microangiopathic haemolytic anaemia and mucin-forming adenocarcinoma. Br J Haematol. 1970; 18: 183-193. PubMed: https://pubmed.ncbi.nlm.nih.gov/5439525/
  13. Pineo GF, Regoeczi E, Hatton MW, Brain MC. The activation of coagulation by extracts of mucus: a possible pathway of intravascular coagulation accompanying adenocarcinomas. J Lab Clin Med. 1973; 82: 255-266. PubMed: https://pubmed.ncbi.nlm.nih.gov/4352814/
  14. Shao B, Wahrenbrock MG, Yao L, David T, Coughlin SR, et al. Carcinoma mucins trigger reciprocal activation of platelets and neutrophils in a murine model of Trousseau syndrome. Blood. 2011; 118: 4015-4023. PubMed: https://pubmed.ncbi.nlm.nih.gov/21860019/
  15. Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012; 158: 323-335. PubMed: https://pubmed.ncbi.nlm.nih.gov/22624596/
  16. Caramello V, Dovio A, Caraci P, Berruti A, Angeli A. Thrombotic thrombocytopenic purpura in advanced prostate cancer: case report and published work review. Int J Urol. 2007;14: 150-152. PubMed: https://pubmed.ncbi.nlm.nih.gov/17302573/
  17. Basic-Jukic N, Kes P, Bubic-Filipi L, Brunetta B. Treatment of thrombotic microangiopathies with plasma exchange. Hematology. 2007; 12: 63-67. PubMed: https://pubmed.ncbi.nlm.nih.gov/17364995/
  18. Subramaniam S, Choufani E, Manov A. Lack of energy, petechiae, elevated PSA level--Dx? J Fam Pract. 2014; 63: 565-567. PubMed: https://pubmed.ncbi.nlm.nih.gov/25343154/
  19. Innes A, Bernard T, Cotton RE, Burden RP. Recurrent haemolytic uraemic syndrome in the elderly associated with metastatic carcinoma. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association. Nephrol Dial Transplant. 1990; 5: 886-888. PubMed: https://pubmed.ncbi.nlm.nih.gov/2128386/
  20. Van der Merwe WM, Collins JF. The haemolytic uraemic syndrome and prostatic carcinoma. N Z Med J. 1987;100: 483-485. PubMed: https://pubmed.ncbi.nlm.nih.gov/3455512/
  21. Sennesael JJ, Vanden Houte KM, Spapen HD, de Bruyne RM, Verbeelen DL. Recurrent hemolytic uremic syndrome and metastatic malignancy. Am J Nephrol. 1987; 7: 60-64. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3578376
  22. Biers SM, Sullivan ME, Roberts IS, Noble JG. Thrombotic microangiopathy in advanced prostatic carcinoma. Urology. 2004; 63: 380-382. PubMed: https://pubmed.ncbi.nlm.nih.gov/14972503/
  23. Kanesvaran R, Phipps C, Cheng CW, Chan MM, Khoo D, Tan MH. Management of thrombotic thrombocytopenic purpura in metastatic prostate cancer with only endocrine therapy. Annals of the Academy of Medicine, Singapore. 2010; 39: 580-582. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732406/
  24. Perkovic V, Came NA, Grigg AP, Becker GJ. Haemolytic uraemic syndrome and prostatic cancer. Aust N Z J Med. 1999; 29: 383-384. PubMed: https://pubmed.ncbi.nlm.nih.gov/10868509/
  25. Furlan M, Robles R, Galbusera M, Remuzzi G, Kyrle PA, Brenner B, et al. von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. N Engl J Med. 1998; 339: 1578-1584. PubMed: https://pubmed.ncbi.nlm.nih.gov/9828245/
  26. Lammle B, Kremer Hovinga JA, George JN. Acquired thrombotic thrombocytopenic purpura: ADAMTS13 activity, anti-ADAMTS13 autoantibodies and risk of recurrent disease. Haematologica. 2008; 93: 172-177. PubMed: https://pubmed.ncbi.nlm.nih.gov/18245649/
  27. Peyvandi F, Ferrari S, Lavoretano S, Canciani MT, Mannucci PM. von Willebrand factor cleaving protease (ADAMTS-13) and ADAMTS-13 neutralizing autoantibodies in 100 patients with thrombotic thrombocytopenic purpura. Br J Haematol. 2004; 127: 433-439. PubMed: https://pubmed.ncbi.nlm.nih.gov/15521921/
  28. Ono T, Mimuro J, Madoiwa S, Soejima K, Kashiwakura Y, Ishiwata A, et al. Severe secondary deficiency of von Willebrand factor-cleaving protease (ADAMTS13) in patients with sepsis-induced disseminated intravascular coagulation: its correlation with development of renal failure. Blood. 2006; 107: 528-534. PubMed: https://pubmed.ncbi.nlm.nih.gov/16189276/
  29. Vesely SK, George JN, Lammle B, Studt JD, Alberio L, El-Harake MA, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood. 2003; 102: 60-68. PubMed: https://pubmed.ncbi.nlm.nih.gov/12637323/
  30. George JN. Measuring ADAMTS13 activity in patients with suspected thrombotic thrombocytopenic purpura: when, how, and why? Transfusion. 2015; 55: 11-13. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295634/
  31. George JN, Vesely SK, Terrell DR. The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) Registry: a community perspective of patients with clinically diagnosed TTP-HUS. Seminars in hematology. 2004; 41: 60-67. PubMed: https://pubmed.ncbi.nlm.nih.gov/14727260/
  32. Kremer Hovinga JA, Vesely SK, Terrell DR, Lammle B, George JN. Survival and relapse in patients with thrombotic thrombocytopenic purpura. Blood. 2010; 115:1500-1511. PubMed: https://pubmed.ncbi.nlm.nih.gov/20032506/
  33. Shah N, Rutherford C, Matevosyan K, Shen YM, Sarode R. Role of ADAMTS13 in the management of thrombotic microangiopathies including thrombotic thrombocytopenic purpura (TTP). Br J Haematol. 2013; 163: 514-519. PubMed: https://pubmed.ncbi.nlm.nih.gov/24111495/
  34. Forman RB, Benkel SA, Novik Y, Tsai HM. Presence of ADAMTS13 activity in a patient with metastatic cancer and thrombotic microangiopathy. Acta Haematologica. 2003; 109: 150-152.
  35. Levy GG, Nichols WC, Lian EC, Foroud T, McClintick JN, McGee BM, et al. Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature. 2001; 413: 488-494. PubMed: https://pubmed.ncbi.nlm.nih.gov/11586351/
  36. Fontana S, Gerritsen HE, Kremer Hovinga J, Furlan M, Lammle B. Microangiopathic haemolytic anaemia in metastasizing malignant tumours is not associated with a severe deficiency of the von Willebrand factor-cleaving protease. Br J Haematol. 2001; 113: 100-102. PubMed: https://pubmed.ncbi.nlm.nih.gov/11328288/
  37. Froehlich-Zahnd R, George JN, Vesely SK, Terrell DR, Aboulfatova K, et al. Evidence for a role of anti-ADAMTS13 autoantibodies despite normal ADAMTS13 activity in recurrent thrombotic thrombocytopenic purpura. Haematologica. 2012; 97: 297-303. PubMed: https://pubmed.ncbi.nlm.nih.gov/21993669/
  38. Lin YC, Chang HK, Sun CF, Shih LY. Microangiopathic hemolytic anemia as an initial presentation of metastatic cancer of unknown primary origin. South Med J. 1995; 88: 683-687. PubMed: https://pubmed.ncbi.nlm.nih.gov/7777893/
  39. Lohrmann HP, Adam W, Heymer B, Kubanek B. Microangiopathic hemolytic anemia in metastatic carcinoma. Report of eight cases. Annals of internal medicine. 1973; 79: 368-375. PubMed: https://pubmed.ncbi.nlm.nih.gov/4748253/
  40. de la Fouchardiere C, Flechon A, Droz JP. Coagulopathy in prostate cancer. The Netherlands journal of medicine. 2003; 61: 347-354. PubMed: https://pubmed.ncbi.nlm.nih.gov/14768717/
  41. Nguyen TC, Han YY. Plasma exchange therapy for thrombotic microangiopathies. Organogenesis. 2011; 7: 28-31. PubMed: https://pubmed.ncbi.nlm.nih.gov/21293177/
  42. Thomas M, Scully M. How I Treat Microangiopathic Hemolytic Anemia in Patients with Cancer. Blood. 2021; 2019003810. PubMed: https://pubmed.ncbi.nlm.nih.gov/33512445/
  43. Vendramin C, McGuckin S, Alwan F, Westwood JP, Thomas M, et al. A single-center prospective study on the safety of plasma exchange procedures using a double-viral-inactivated and prion-reduced solvent/detergent fresh-frozen plasma as the replacement fluid in the treatment of thrombotic microangiopathy. Transfusion. 2017; 57: 131-136. PubMed: https://pubmed.ncbi.nlm.nih.gov/27774620/
  44. Ramos R, Lopes F, Rodrigues T, Rolim N, Rodrigues I, Monteiro H. Advanced prostate cancer presenting as hemolytic uremic syndrome. Case Rep Urol. 2013; 2013: 459618. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657421/
  45. Mungall S, Mathieson P. Hemolytic uremic syndrome in metastatic adenocarcinoma of the prostate. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2002; 40: 1334-1336. PubMed: https://pubmed.ncbi.nlm.nih.gov/12460056/
  46. Muller NJ, Pestalozzi BC. Hemolytic uremic syndrome in prostatic carcinoma. Oncology. 1998; 55: 174-176. PubMed: https://pubmed.ncbi.nlm.nih.gov/9499193/
  47. Milutinovic J, Irby S, Fisher M. Hemolytic uremic syndrome and metastatic malignancy. South Med J. 1982; 75: 1409-1411. PubMed: https://pubmed.ncbi.nlm.nih.gov/7146974/

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