Microangiopathic hemolytic anemia observed after treatment of epidermoid carcinoma with mitomycin C and 5-fluorouracil

✍ Scribed by Subhash C. Gulati; Peter Sordillo; Sanford Kempin; Lilian Reich; Gordon B. Magill; Ellen Scheiner; Bayard Clarkson

• Publisher: John Wiley and Sons
• Year: 1980
• Tongue: English
• Weight: 971 KB
• Volume: 45
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(19800501)45:9<2252::aid-cncr2820450906>3.0.co;2-n

✦ Synopsis

Two patients with epidermoid carcinoma treated with mitomycin-C (Mit-C) and 5-fluorouracil (5-FU) developed microangiopathic hemolytic anemia (MAHA), renal failure, and altered mental status. Patient 1 was free of metastatic disease, on maintenance Mit-C and 5-FU when MAHA changes appeared. Patient 2 had recurrent carcinoma in the pelvic area when MAHA changes appeared. In both patients, MAHA changes and neurologic function improved after exchange plasmapheresis. This is the first report of epidermoid carcinoma manifesting MAHA changes after chemotherapy. Speculation as to pathogenesis and appropriate therapy are discussed.

Cancer 452252-2257, 1980.

ICROANGIOPATHIC HLMOLYTIC ANEMIA (MAHA)

M is characterized by hemolytic anemia, usually with thrombocytopenia, and the presence of fragmented red blood cells in the peripheral smear, and is often found in association with renal failure. Increased deposition of platelets and fibrin in blood vessel is thought to produce red blood cell fragmentation, hemolysis, and thromb~cytopenia.~ Usually, fibrinogen catabolism is not increased, but occasionally there is evidence of increased fibrinogen catabolism4 as well as decreased platelet survival." Recent evidence suggests that patients with thrombotic thrombocytopenic purpura (TTP) and MAHA lack a factor which is present in normal plasma and may inhibit deposition of hemostatic factors or protect vascular integrity;9,20,26,29 this has led to the use of normal plasma transfusion and plasmapheresis in treating patients with TTp.6.9.20.24,29