Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
Department of Clinical Laboratory, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
Cancer Rep (Hoboken). 2024 Mar;7(3):e2036. doi: 10.1002/cnr2.2036.
Cancer-related thrombotic microangiopathy (CR-TMA) is a rare type of Coombs-negative hemolytic anemia, which is caused by malignancy and has a poor prognosis.
A 76-year-old female was referred to our hospital due to Coombs-negative hemolytic anemia, which was causing fatigue and dyspnea on exertion, accompanied by schistocytosis. A bone marrow examination demonstrated bone marrow carcinomatosis, and the tumor cells were morphologically suspected to be signet-ring cell carcinoma cells. As we failed to find the primary tumor site before the patient died, she was diagnosed with CR-TMA due to bone marrow carcinomatosis of unknown primary origin. Thrombotic thrombocytopenic purpura (TTP) was rapidly ruled out based on her PLASMIC score. In addition, immunohistochemical staining of a clot section of the bone marrow and tumor marker data were useful for narrowing down the likely primary tumor site.
Although CR-TMA is an extremely rare phenomenon, clinicians who suspect CR-TMA should quickly rule out TTP and decide whether to provide appropriate chemotherapy or plan for palliative care.
癌症相关性血栓性微血管病（CR-TMA）是一种罕见的 Coombs 阴性溶血性贫血，由恶性肿瘤引起，预后不良。
一名 76 岁女性因 Coombs 阴性溶血性贫血就诊，该贫血导致乏力和活动时呼吸困难，伴有棘形红细胞。骨髓检查显示骨髓转移癌，形态学上怀疑肿瘤细胞为印戒细胞癌。由于患者死亡前未能找到原发肿瘤部位，故诊断为骨髓转移癌来源不明的 CR-TMA。根据 PLASMIC 评分迅速排除血栓性血小板减少性紫癜（TTP）。此外，骨髓血栓切片的免疫组织化学染色和肿瘤标志物数据有助于缩小可能的原发肿瘤部位。
尽管 CR-TMA 极为罕见，但怀疑 CR-TMA 的临床医生应迅速排除 TTP，并决定是否提供适当的化疗或计划姑息治疗。
