THROMBOTIC THROMBOCYTOPENIC PURPURA IN PATIENTS SUFFERING OF CANCER
Abstract
Background. Thrombotic thrombocytopenic purpura (TTP) is a rare group of symptoms, characterized by microangiopathic haemolytic anemia, thrombocytopenia, neurological symptoms, fever and renal affection. Beside other causes, TTP is a rare symptom in cancer. TTP must be treated immediately and it is necessary to search for its cause.
Patients. In the article two patients with acute TTP are represented. When searching for the reason of TTP, in first patient gastric carcinoma and in second patient peritoneal carcinosis and later breast carcinoma were established. Before surgical treatment, both patients were treated with repeated plasmapheresis.
Conclusions. Treatment of acute form of TTP in cancer patients is the same as in other diseases, especially to softening the symptoms and to make possible the surgical treatment. Further course of TTP depends on disease extension.
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References
George JN, El-Harake M. Thrombocytopenia due to enhanced platelet destruction by nonimmunologic mechanisms. In: Beutler E, Lichtman MA, Coller BS eds. Williams hematology. New York, St. Louis: McGraw-Hill, 1995: 1290–315.
Moake JL. Thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. In: Hoffman R, Benz EJ Jr. eds. Hematology. New York, Edinburgh: Churchill Livingstone, 1995: 1879–89.
Kwaan HC. Clinicopathologic features of thrombotic thrombocytopenic purpura. Semin Hematol 1987; 24: 71–81.
Bick RL. Quantitative platelet defects. In: Bick RL, Bennett JM eds. Hematology. St. Louis, Baltimore: Mosby, 1993: 1337–68.
Sill H, Höfler G, Kaufmann P, Horina J, Spuller E, Kleinert R. Angiotropic large cell lymphoma presenting as thrombotic microangiopathy (thrombotic thrombocytopenic purpura). Cancer 1995; 75: 1167–70.
Arai S, Allan C, Streiff M, Hutchins GM et al. Von Willebrand factor-cleaving protease activity and proteolysis of von Willebrand factor in bone marrow transplant-associated thrombotic microangiopathy. The Hematology Journal 2001; 2: 292–9.
Siddiqui FA, Lian ECY. Novel platelet agglutinating protein from a thromboting thrombocytopenic purpura plasma. J Clin Invest 1985; 76: 1330–7.
Furlan M, Lämmle B. Aetiology and pathogenesis of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome: the role of von Willebrand factor-cleaving protease. Best Practice Research Clin Haematol 2001; 14: 437–54.
Furlan M, Robles R, Galbusera M, Remuzzi G, Kyrle P et al. Von Willebrand factor – cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic – uremic syndrome. N Engl J Med 1998; 339: 1578–83.
Moake JL, Rudy CK, Troll JH et al. Unusually large plasma factor VIII: von Willebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Engl J Med 1982; 307: 1432–5.
Tsai HM, Lian ECY. Antibodies to von Willebrand factor-cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med 1998; 339: 1585–94.
Chen YC, McLeod B, Hall ER, Wu KK. Accelerated prostacyclin degradation in thrombotic thrombocytopenic purpura. Lancet 1981; 2: 267–9.
Lohrmann HP, Adam W, Heymer B et al. Microangiopathic hemolytic anemia in metastatic carcinoma: report of 8 cases. Ann Intern Med 1973; 79: 368–75.
Schiffer CA. Thrombocytopenia in cancer patients. Triangle 1993; 32: 53–7.
Von Bubnoff N, Sandherr M, Schneller F, Peschel C. Thrombotic thrombocytopenic purpura in metastatic carcinoma of the breast. Am J Clin Oncol 2000; 23: 74–7.
Lesesne JB, Rotschild N, Erickson B et al. Cancer associated hemolyticuremic syndrome: analysis of 85 cases from a national registry. J Clin Oncol 1989; 6: 781–9.
Gordon LI, Kwaan HC. Thrombotic microangiopathy manifesting as thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in cancer patient. Sem Thromb Hemost 1999; 25: 217–21.
Nagaya S, Wada H, Oka K et al. Hemostatic abnormalities and increased vascular endothelial cell markers in patients with red cell fragmentation syndrome induced by mitomycin C. Am J Hematol 1995; 50: 237–43.
Rock G, Porta C, Bobbio-Pallavicini E. Thrombotic thrombocytopenic purpura treatment in year 2000. Haematologica 2000; 85: 410–9.
Pineda AA, Vamvakas EC. Applications of therapeutic apheresis in patients with malignant disease. Oncologist 1997; 2: 94–103.
Rock GA, Shumak KH, Buskard NA et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. N Engl J Med 1991; 325: 393–7.
Joneau M, Cordonnier C, Vernant JP et al. How many plasma exchanges to cure thrombotic thrombocytopenic purpura? Scan J Haematol 1985; 34: 157–9.
Moake JL. TTP – desperation, empiricism, progress. N Engl J Med 1991; 325: 398–403.
Ucar A, Fernandez HF, Byrnes JJ et al. Thrombotic microangiopathy and retroviral infections: a 13 year experience. Am J Hematol 1994; 45: 304–9.
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