Microangiopathic hemolytic anemia/Acquired Thrombotic Thrombocytopenic Purpura as a first presentation of pancreatic cancer

Microangiopathic hemolytic anemia/Acquired Thrombotic Thrombocytopenic Purpura as a first presentation of pancreatic cancer

Meshaal Alanzi1, Khalid E. Ahmed1, Bassel Dakkak1, Mhd Baraa Habib1, Ahmed O. Saleh2, Mohamed A. Yassin3, Shehab F. Mohamed3

1.Department of Internal Medicine, Hamad medical corporation, Doha, Qatar;2.Department of Endocrinology, Hamad medical corporation, Doha, Qatar; 3.Department of Hematology, National center for cancer care and research, Hamad medical corporation, Doha, Qatar.

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Thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening hematologic disorder. It is mainly characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, renal impairment and neurological abnormality. Plasmapheresis and steroids are the standard of care.

MAHA/TTP can be the initial presentation of solid organ malignancies especially gastrointestinal tumors. We report a 56-year-old female patient who presented with progressive back pain, tiredness, easy bruising, fever and weight loss. Laboratory results showed anemia, thrombocytopenia, and schistocytes in the peripheral smear. An initial diagnosis of thrombotic thrombocytopenic purpura (TTP) was made on the basis of clinical presentation and lab findings. She was treated with corticosteroids and plasma exchange but with no major response.

CT abdomen and PET CT were suggestive of pancreatic carcinoma with extensive lymph nodal, organs and bone metastases. Supraclavicular lymph node biopsy was compatible with metastatic adenocarcinoma. As a result, the diagnosis of pancreatic cancer was established and the decision was for palliative treatment.

This case highlights the need to consider malignancy in patients with MAHA/TTP especially if it does not respond to plasmapheresis. Hence, the treatment of MAHA/TTP could be directed to the underlying malignancy if available.

Keywords: TTP, pancreatic cancer, plasmapheresis

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How to cite this article:

Meshaal Alanzi, Khalid E. Ahmed, Bassel Dakkak, Mhd Baraa Habib, Ahmed O. Saleh, Mohamed A. Yassin, Shehab F. Mohamed. Microangiopathic hemolytic anemia/Acquired Thrombotic Thrombocytopenic Purpura as a first presentation of pancreatic cancer . International Journal of Case Reports, 2020 4:143. DOI: 10.28933/ijcr-2020-06-1605


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