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Elsherif S, Zidan A, Saville O, Othman M. ABO Blood Group and the Risk of Thrombosis in Cancer Patients: A Mini-Review. Semin Thromb Hemost 2024; 50:423-428. [PMID: 37751774 DOI: 10.1055/s-0043-1775568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Cancer-associated thrombosis (CT), especially venous thromboembolism (VTE), is a common occurrence with several factors contributing to a wide diversity in thrombosis risk. The association between ABO blood groups and the risk for CT has been examined in various studies, with non-O blood type associated with an increased thrombosis risk; however, these studies have reported varying results with recognized limitations. ABO blood groups are known to be implicated in hemostasis, in an association mediated through von Willebrand factor (VWF). In this narrative review, we aim to summarize the current knowledge surrounding the role of ABO blood groups in VTE, with a particular focus on the role of VWF and other contributing risk factors on VTE occurrence. We found evidence from literature for the impact of ABO blood groups in determining the risk of VTE in healthy populations, with a limited number of studies examining this effect in cancer patients. Additionally, research on the impact of ABO on different cancer types lacks rigor, particularly in regard to other risk factors. Overall, most studies showed strong association of increased risk of VTE amongst cancer patients with non-O blood groups and increased VWF levels. This association was weaker in a few studies. Further research is needed before a solid conclusion can be made about the ABO or ABO-VWF-mediated hypercoagulability and VTE risk in various cancers. These studies will help determine if ABO typing can be an added biomarker to improve VTE risk assessment models in cancer patients.
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Affiliation(s)
- Salah Elsherif
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ali Zidan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Olivia Saville
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Nursing, School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansura, Egypt
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2
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Jackson DL, Coke L, Oni O, Taddesse-Heath L. Undiagnosed Metastatic Breast Carcinoma Presenting as Thrombotic Thrombocytopenic Purpura. Cureus 2023; 15:e44452. [PMID: 37791199 PMCID: PMC10544154 DOI: 10.7759/cureus.44452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Cancer-associated thrombotic microangiopathy has a documented relationship with metastatic disease. Other examples of thrombotic microangiopathy (TMA) include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). All these conditions can present with microangiopathic hemolytic anemia as well as thrombocytopenia. However, when these findings occur in association with cancer, they often carry a poor prognosis. Though associated with metastasis, microangiopathic hemolytic anemia, and thrombocytopenia have rarely been seen as the presenting signs of malignancy. We present the case of a 66-year-old female with no known history of cancer who exhibited an intriguing clinical presentation, including progressive dyspnea worsening with exertion, diarrhea, and dizziness. Laboratory investigations revealed Coombs-negative hemolytic anemia with schistocytes on blood smears and thrombocytopenia. The patient's condition raised concerns for TTP, prompting the initiation of plasmapheresis. However, despite treatment, the anemia and thrombocytopenia showed no improvement, leading to further investigations. Ultimately, a bone marrow biopsy revealed tumor cells arranged in nests and single files, leading to a diagnosis of metastatic carcinoma, consistent with breast primary. This was the patient's first known sign of breast cancer. This case emphasizes the significance of considering metastatic cancer as a potential differential diagnosis in patients presenting with similar signs and symptoms.
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Affiliation(s)
- Devon L Jackson
- Pathology and Laboratory Medicine, Howard University Hospital, Washington, DC, USA
| | - Lamarque Coke
- Pathology and Laboratory Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Olanrewaju Oni
- Pathology and Laboratory Medicine, Howard University Hospital, Washington, DC, USA
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3
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Gupta S, Gudsoorkar P, Jhaveri KD. Acute Kidney Injury in Critically Ill Patients with Cancer. Clin J Am Soc Nephrol 2022; 17:1385-1398. [PMID: 35338071 PMCID: PMC9625110 DOI: 10.2215/cjn.15681221] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Advances in cancer therapy have significantly improved overall patient survival; however, AKI remains a common complication in patients with cancer, occurring in anywhere from 11% to 22% of patients, depending on patient-related or cancer-specific factors. Critically ill patients with cancer as well as patients with certain malignancies (e.g., leukemias, lymphomas, multiple myeloma, and renal cell carcinoma) are at highest risk of developing AKI. AKI may be a consequence of the underlying malignancy itself or from the wide array of therapies used to treat it. Cancer-associated AKI can affect virtually every compartment of the nephron and can present as subclinical AKI or as overt acute tubular injury, tubulointerstitial nephritis, or thrombotic microangiopathy, among others. AKI can have major repercussions for patients with cancer, potentially jeopardizing further eligibility for therapy and leading to greater morbidity and mortality. This review highlights the epidemiology of AKI in critically ill patients with cancer, risk factors for AKI, and common pathologies associated with certain cancer therapies, as well as the management of AKI in different clinical scenarios. It highlights gaps in our knowledge of AKI in patients with cancer, including the lack of validated biomarkers, as well as evidence-based therapies to prevent AKI and its deleterious consequences.
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Affiliation(s)
- Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prakash Gudsoorkar
- Division of Nephrology & Kidney Clinical Advancement, Research & Education Program, University of Cincinnati, Cincinnati, Ohio
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Great Neck, New York
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4
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Jalali S, Jenneman D, Tandon A, Khong H. Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide. In Vivo 2021; 35:1885-1888. [PMID: 33910877 DOI: 10.21873/invivo.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Thrombotic microangiopathy (TMA) is a clinical syndrome consisting of hemolytic anemia, thrombocytopenia, and presence of schistocytes on peripheral blood smear secondary to disorders of systemic microvascular thrombosis. Malignancy-associated TMA is a rare entity and shares clinical features with that of HUS and TTP usually seen in patients with metastatic cancer, tumor cell infiltration of the bone marrow and/or response to cancer-directed therapy. CASE REPORT We present a rare case of TMA secondary to breast cancer without evidence of bone marrow infiltration responsive to doxorubicin and cyclophosphamide treatment, after failed plasmapheresis with prednisone and later, eculizumab. CONCLUSION Despite being a rare manifestation of metastatic carcinoma, early identification and treatment are essential to improving survival.
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Affiliation(s)
- Samuel Jalali
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL, U.S.A.;
| | - Dakota Jenneman
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, U.S.A
| | - Ankita Tandon
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, U.S.A
| | - Hung Khong
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, FL, U.S.A
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5
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Alhenc-Gelas M, Bidard FC. [Breast cancer-related thrombotic microangiopathy: A review]. Bull Cancer 2021; 108:730-739. [PMID: 34052032 DOI: 10.1016/j.bulcan.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/15/2022]
Abstract
Thrombotic Microangiopathies (TM) have been described since the 1960s. They are characterized by presence of mechanical haemolytic anemia associated with peripheral thrombocytopenia. TM in cancer can be related to several causes, whose cancer himself: cancer-related microangiopathic haemolytic anaemia (MAHA). Incidence of cancer related MAHA remains unknown. Cancer-related MAHA are mainly observed in mucin-producer adenocarcinomas, such as gastric (half of reported cases) and breast cancer. We conducted a review of all original published cases of TM reported in breast cancer, and we specifically investigated BC-MAHA cases. A Medline search identified 158 MAHA cases including 118 BC-MAHA, and 40 drug-related MAHA. Most of BC-MAHA occur in disseminated cancers, mainly with medullar involvement, and/or bone metastasis. Patients typically suffer from poor general state, bone pain, and/or dyspnea. Laboratory abnormalities such as myelemia or erythromyelemia in peripheral blood are frequently observed. Incidence of coagulation disorders is increased, compared to other MAHA causes. BC-MAHA prognosis is dramatically poor. Treatments classically used in other MAHA causes, such as plasmapheresis or immunoglobulins, are inefficient. Urgent anti-neoplastic therapy may be the only effective treatment, associated to symptomatic therapies (transfusions, blood pressure control).
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Affiliation(s)
- Marion Alhenc-Gelas
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France.
| | - François-Clément Bidard
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France.
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Osti N, Beschin G, Goldin M, Guidolin L, Panero E, Sartori A, Parisi A, Cantini M, Pizzolo F, Olivieri O, Friso S. Case Report: Microangiopathic Hemolytic Anemia With Normal ADAMTS13 Activity. Front Med (Lausanne) 2021; 8:589423. [PMID: 33738292 PMCID: PMC7960662 DOI: 10.3389/fmed.2021.589423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022] Open
Abstract
Thrombotic microangiopathies (TMAs) include a heterogeneous group of diseases characterized by abnormalities in the vessel walls of arterioles and capillaries resulting in microvascular thrombosis that typically presents with a microangiopathic hemolytic anemia (MAHA) and severe thrombocytopenia. We describe here the case of an 82-year-old woman, who came to our attention for a clinical condition consistent with thrombotic microangiopathy. Even if initially highly suggestive for a thrombotic thrombocytopenic purpura (TTP), the elevated ADAMTS13 activity together with the alteration of the main coagulation parameters (D-dimer elevation, fibrinogen consumption, slightly prolonged prothrombin time), induced us to consider several other diseases in the differential diagnostic process. The case evolved toward a suspected overlapped secondary hemophagocytic syndrome, though the hyperferritinemia was finally interpreted within the frame of a cytokine storm. After a complex diagnostic workup, the clinical and biochemical parameters guided us toward the diagnosis of a cancer-related microangiopathic hemolytic anemia (CR-MAHA) secondary to a relapsing breast cancer with multiple metastatic localizations. Prednisone 1 mg/kg body weight was started, and several units of fresh frozen plasma were infused, obtaining a good control of the hemolysis. No specific oncological therapies were, however, possible, due to the older age and the critically compromised general condition of the patient; therefore, after clinical stabilization, the patient was discharged for treatment in a palliative care Hospital.
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Affiliation(s)
- Nicola Osti
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Greta Beschin
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Marzia Goldin
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Lucia Guidolin
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Enrico Panero
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Alice Sartori
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Alice Parisi
- Department of Diagnostics and Public Health, School of Medicine, University of Verona, Verona, Italy
| | - Maurizio Cantini
- Department of Transfusion Medicine, University Hospital, Verona, Italy
| | - Francesca Pizzolo
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Oliviero Olivieri
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Simonetta Friso
- Department of Medicine, School of Medicine, University of Verona, Verona, Italy
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7
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Alhenc-Gelas M, Cabel L, Berger F, Delaloge S, Frenel JS, Levy C, Firmin N, Ladoire S, Desmoulins I, Heudel PE, Dalenc F, Loirat D, Dubot C, Vuagnat P, Deluche E, Mokdad-Adi M, Patsouris A, Annic J, Djerroudi L, Lavigne M, Pierga JY, Coppo P, Bidard FC. Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study. Breast Cancer Res 2021; 23:9. [PMID: 33468209 PMCID: PMC7814553 DOI: 10.1186/s13058-021-01386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA. METHODS Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records. RESULTS Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N = 39, 75%). ER+/HER2-, HER2+ and triple-negative phenotypes accounted for N = 33 (69%), N = 7 (15%) and N = 8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28 days (range 0-1035; Q1:10, Q3:186). Independent prognostic factors for early death (≤ 28 days) were PS > 2 (OR = 7.0 [1.6; 31.8]), elevated bilirubin (OR = 6.9 [1.1; 42.6]), haemoglobin < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]). CONCLUSIONS Breast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.
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Affiliation(s)
- Marion Alhenc-Gelas
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Institut de cancérologie de Montpellier INSERM U1194, Montpellier, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Toulouse, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Elise Deluche
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Meriem Mokdad-Adi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Josselin Annic
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Université de Paris, Paris, France
| | - Paul Coppo
- Reference Center for Thrombotic Microangiopathies (CNR-MAT), AP-HP.SU, INSERM UMRS, 1138, Paris, France.,Sorbonne University, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France. .,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France.
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8
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Van de Louw A, Cohrs A, Leslie D. Clinical Features and Outcome of Thrombotic Microangiopathies: Comparison between Patients with and without Malignancy. Thromb Haemost 2020; 121:565-572. [PMID: 33186993 DOI: 10.1055/s-0040-1720974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Thrombotic microangiopathy (TMA) is an uncommon complication of cancers, related to the malignancy itself, antineoplastic drugs, or hematopoietic stem cell transplant. It was reported mostly as case series but large data are lacking. We used the large U.S. MarketScan database to compare TMA between patients with and without malignancy. Adult patients hospitalized between 2005 and 2014 with a diagnosis of TMA were included; cancer patients were defined by a diagnosis of cancer within 1 year prior to or during the admission with TMA. Associated inpatient diagnoses, procedures, hospital mortality, and long-term survival were collected. We included 3,227 patients; 617 (19.1%) had cancer (age 54 [44-60] years, 58% female), which was a new diagnosis for 23% of patients. Two-thirds of cancer patients had solid tumors (mostly pancreas, lung, breast, colorectal, and hepatobiliary, half of them metastatic) and one-third had hematological malignancies (lymphoma, acute leukemia, and multiple myeloma); TMA patients with cancer were older, more often men, had more noncancer-related comorbidities, and developed more sepsis and coagulopathy than TMA patients without cancer. Hospital mortality was significantly higher in cancer patients (16.6% vs. 6.1%, p < 0.001) and reached 30% in transplant recipients; malignancy was an independent risk factor for hospital mortality in multivariate analysis and sensitivity analyses excluding patients with metastases or patients who did not undergo plasmapheresis led to similar results. Malignancy was also associated with decreased long-term survival.
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Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Austin Cohrs
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
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9
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Palbociclib-Induced Thrombotic Microangiopathy in Metastatic Breast Cancer Patient Surviving for 18 Years: Case Report and Review of the Literature. Clin Breast Cancer 2017; 18:e263-e266. [PMID: 29153774 DOI: 10.1016/j.clbc.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/13/2017] [Accepted: 10/01/2017] [Indexed: 12/15/2022]
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10
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Crivellenti LZ, Silva GEB, Borin-Crivellenti S, Cianciolo R, Adin CA, Dantas M, dos Anjos DS, Tinucci-Costa M, Santana AE. Prevalence of Glomerulopathies in Canine Mammary Carcinoma. PLoS One 2016; 11:e0164479. [PMID: 27764139 PMCID: PMC5072677 DOI: 10.1371/journal.pone.0164479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/25/2016] [Indexed: 12/22/2022] Open
Abstract
The incidence and prevalence of paraneoplastic glomerulopathy, especially associated with carcinoma, are a matter of debate and the causal link between cancer and glomerular diseases remains unclear. The aim of this study was to evaluate renal biopsies of selected bitches with spontaneous mammary gland carcinoma. We hypothesized that dogs with mammary carcinomas would show histologic evidence of glomerular pathology. A prospective study was performed in dogs with naturally occurring mammary carcinoma that were undergoing tumor resection and ovariohysterectomy. We evaluated renal biopsies of 32 bitches with spontaneous mammary gland carcinoma and 11 control dogs without mammary gland neoplasia. Samples were obtained from the left kidney and the biopsy material was divided for light microscopy (LM), immunofluorescence (IF) and transmission electron microscopy (TEM). Light microscopy abnormalities were identified in 78.1% of dogs with mammary carcinoma (n = 25) and in none of the dogs in the control group. Focal glomerular mesangial matrix expansion was the most common alteration (n = 15, 60.0%), but mesangial cell proliferation (n = 9, 36.0%) and focal segmental glomerulosclerosis (n = 9, 36.0%), synechiae (n = 7, 28.0%), and globally sclerotic glomeruli (n = 6, 24.0%) were also frequent in dogs with malignancy. Immunofluorescence microscopy revealed strong IgM staining was demonstrated in 64.3% (n = 18) of carcinoma dogs. Transmission electron microscopy from dogs with carcinoma revealed slight changes, the most frequent of which was faint sub-endothelial and mesangial deposits of electron-dense material (78%). Mesangial cell interpositioning and segmental effacement of podocyte foot processes were identified in some specimens (45%). Changes in the glomerulus and proteinuria are common in dogs with naturally occurring mammary carcinoma and this condition appears to provide an excellent large animal model for cancer-associated glomerulopathy in humans.
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Affiliation(s)
- Leandro Z. Crivellenti
- Department of Veterinary Clinic and Surgery, Franca University (UNIFRAN), Franca, Brazil
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
- Department of Renal Pathology, Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
- * E-mail:
| | - Gyl E. B. Silva
- Department of Renal Pathology, Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
| | - Sofia Borin-Crivellenti
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - Rachel Cianciolo
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, United States of America
| | - Christopher A. Adin
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, United States of America
| | - Márcio Dantas
- Department of Internal Medicine (Division of Nephrology), Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
| | - Denner S. dos Anjos
- Department of Veterinary Clinic and Surgery, Franca University (UNIFRAN), Franca, Brazil
| | - Mirela Tinucci-Costa
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - Aureo E. Santana
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
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11
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Pépin M, Kleinjan A, Hajage D, Büller HR, Di Nisio M, Kamphuisen PW, Salomon L, Veyradier A, Stepanian A, Mahé I. ADAMTS-13 and von Willebrand factor predict venous thromboembolism in patients with cancer. J Thromb Haemost 2016; 14:306-15. [PMID: 26589836 DOI: 10.1111/jth.13205] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED ESSENTIALS: Cancer patients are at high risk of venous thromboembolism (VTE). In this study, cases and controls were cancer patients who did or did not develop VTE. von Willebrand factor (VWF) levels were higher if compared with controls and correlated with cancer stage. VWF and ADAMTS-13 are associated with the occurrence of VTE in cancer. BACKGROUND Patients with cancer are at high risk of venous thromboembolism (VTE). ADAMTS-13 regulates von Willebrand factor (VWF) activity, which plays a role in the development of cancer and in VTE. OBJECTIVES The aim of this study was to search for an association between the levels of VWF and ADAMTS-13 and VTE in patients with cancer and to compare current scoring systems for prediction of VTE before and after addition of these parameters. PATIENTS/METHODS In a case-control study, in which patients with recently diagnosed cancer were followed-up for 6 months, we compared 20 patients who developed VTE (cases) and 140 patients with cancer without VTE (controls), matched for sex, age, and type and stage of cancer. We measured VWF, ADAMTS-13 (activity and antigen), P-selectin, D-dimer and F1 + 2 levels at baseline, and calculated both the Khorana score and the Khorana score expanded after addition of P-selectin and D-dimer levels. RESULTS VWF levels were significantly higher in cases when compared with controls (326 ± 185% vs. 242 ± 158%) and correlated with advanced stage of cancer: localized, 185 [142; 222]; locally advanced, 240 [146; 257]; metastatic, 267 [153; 324] (mean [interquartile range]). The addition of two biomarkers, ADAMTS-13 activity and F1 + 2 levels, to the Khorana score improved receiver operating curves. CONCLUSIONS von Willebrand factor and ADAMTS-13 are associated with the occurrence of VTE in patients with cancer. Moreover, addition of ADAMTS-13 and F1 + 2 levels to the Khorana score considerably increases the predictive value for VTE.
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Affiliation(s)
- M Pépin
- Service de Médecine Interne, Hôpital Louis Mourier (AP-HP), Colombes, France
- Unité 1176, INSERM, Le Kremlin-Bicêtre, France
| | - A Kleinjan
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - D Hajage
- Département d'Epidémiologie et Recherche Clinique, URC Paris-Nord, Hôpital Bichat-Claude Bernard (AP-HP), Paris, France
- INSERM, CIC 1425-EC, UMR1123, Paris, France
| | - H R Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio, Chieti, Italy
| | - P W Kamphuisen
- Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L Salomon
- Département de Recherche, Centre Ophtalmologique Rothschild, Paris, France
| | - A Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière (AP-HP), Paris, France
- Universitaire Paris Diderot, EA 7334 REMES Sorbonne Paris Cité, Paris, France
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA3518, Paris, France
| | - A Stepanian
- Service d'Hématologie biologique, Hôpital Lariboisière (AP-HP), Paris, France
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA3518, Paris, France
| | - I Mahé
- Service de Médecine Interne, Hôpital Louis Mourier (AP-HP), Colombes, France
- Universitaire Paris Diderot, EA 7334 REMES Sorbonne Paris Cité, Paris, France
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA3518, Paris, France
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12
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Chalasani P, Segar JM, Marron M, Stopeck A. Pathophysiology of tumour-induced microangiopathic haemolytic anaemia. BMJ Case Rep 2016; 2016:bcr-2015-213521. [PMID: 26744538 DOI: 10.1136/bcr-2015-213521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cancer-associated microangiopathic haemolytic anaemia (CA-MAHA) is a syndrome characterised by Coombs-negative haemolytic anaemia and thrombocytopenia. It is primarily seen in advanced solid tumours and is distinct from thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome. Diagnosis is often delayed and patients have a high mortality. We present the case of CA-MAHA in a patient with metastatic breast cancer treated successfully with early initiation of chemotherapy. In addition, we report longitudinal laboratory evaluation of circulating tumour cells and microparticles and suggest a hypothesis for the mechanism behind CA-MAHA.
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Affiliation(s)
| | - Jennifer M Segar
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Marilyn Marron
- University of Arizona Cancer Center, Tucson, Arizona, USA
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13
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Butler MJ, Yin M, Quddus F. Isolated hemolytic anemia: an unusual manifestation of occult malignancy. Hematol Rep 2014; 6:5159. [PMID: 24711918 PMCID: PMC3977155 DOI: 10.4081/hr.2014.5159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/24/2013] [Accepted: 01/12/2014] [Indexed: 01/28/2023] Open
Abstract
Hemolysis is an uncommon and usually late complication of malignancy, and very rarely the presenting feature. Cancer-associated hemolysis may be immune-mediated, or may result from thrombotic microangiopathy accompanied by thrombocytopenia. We describe an unusual case of isolated hemolysis in the setting of occult metastatic breast cancer. The patient initially presented with symptomatic anemia, with evidence of hemolysis but with negative direct antiglobulin testing and a normal platelet count. Subsequent investigation discovered metastatic adenocarcinoma of the breast involving bone marrow. Hemolysis worsened despite initial treatment with cytotoxic chemotherapy and a trial of corticosteroids, but later resolved with aromatase inhibitor therapy.
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Affiliation(s)
- Matthew J Butler
- Department of Internal Medicine, Geisinger Medical Center , Danville, PA, USA
| | - Ming Yin
- Department of Internal Medicine, Geisinger Medical Center , Danville, PA, USA
| | - Fahd Quddus
- Department of Hematology and Oncology, Geisinger Medical Center , Danville, PA, USA
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14
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Kok VC, Wu SC, Lee CK. Successful Remission of Hemolytic-Uremic Syndrome During the Third-line Weekly Gemcitabine for Metastatic Breast Cancer. Breast Cancer (Auckl) 2014; 8:57-9. [PMID: 24701120 PMCID: PMC3972075 DOI: 10.4137/bcbcr.s14920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 02/07/2023] Open
Abstract
Sequential palliative chemotherapy for metastatic breast cancer incorporating weekly gemcitabine administered as three-weeks-on, one-week-off schedule is widely adopted throughout the East Asia region. Hemolytic-uremic syndrome (HUS) associated with weekly gemcitabine for a breast cancer patient is extremely rare. We report here a case of 43-year-old woman with metastatic breast cancer who received weekly gemcitabine as a third-line palliative chemotherapy for her disease. She developed HUS after a cumulative dose of 11,000 mg/m(2) gemcitabine, evidenced by microangiopathic hemolytic anemia (MAHA) with schistocytes seen in peripheral blood smear, decreased haptoglobin level (<0.29 mmol/L), thrombocytopenia, negative direct Coombs test, and acute kidney injury. Owing to the ease of administration of weekly gemcitabine, gemcitabine-induced thrombocytopenia, multifactorial anemia in metastatic breast cancer, and possibility of cancer progression, HUS could have gone unnoticed. Breast cancer oncologist should be cognizant of this rare HUS even during weekly gemcitabine treatment.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Shalu, Taichung, Taiwan
- Department of Biomedical Informatics, Asia University, Wufeng, Taichung, Taiwan
- CORRESPONDENCE: ;
| | - Sheng-Chung Wu
- Division of Breast Surgery, Department of Surgery, Kuang Tien General Hospital, Tachia, Taichung, Taiwan
| | - Chien-Kuang Lee
- Department of Pathology, Kuang Tien General Hospital, Shalu, Taichung, Taiwan
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15
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Fatal Oxaliplatin-Induced Thrombotic Thrombocytopenic Purpura: A Case Report. Clin Colorectal Cancer 2013; 12:294-6. [DOI: 10.1016/j.clcc.2013.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/02/2013] [Accepted: 09/16/2013] [Indexed: 11/23/2022]
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