Picture this:
A patient with breast cancer is found unconscious at home, and you find this π on your evaluation.
Whatβs going on? π€
𧡠1/6
A patient with breast cancer is found unconscious at home, and you find this π on your evaluation.
Whatβs going on? π€
𧡠1/6
To guide our thoughts, letβs start with 3 thrombotic microangiopathy (TMA) facts-
1) TMA is a syndrome of RBC hemolysis via direct trauma from thrombi in small vessels
2) π Cancer-associated TMA has a one-month mortality of ~50% π€―
𧡠2/6
1) TMA is a syndrome of RBC hemolysis via direct trauma from thrombi in small vessels
2) π Cancer-associated TMA has a one-month mortality of ~50% π€―
𧡠2/6
Cancer-associated TMA happens when cancer cells circulate in the blood and lead toβ¦
1οΈβ£ fibrin deposition
and 2οΈβ£ small vessel occlusion
Imagine RBCs being sheared as they squeeze through these fibrin bandsπ π€―
𧡠3/6
1οΈβ£ fibrin deposition
and 2οΈβ£ small vessel occlusion
Imagine RBCs being sheared as they squeeze through these fibrin bandsπ π€―
𧡠3/6
With this high mortality in mindβ¦
Which therapy β¬οΈ overall survival for cancer-associated TMA? π€
𧡠4/6
Which therapy β¬οΈ overall survival for cancer-associated TMA? π€
𧡠4/6
π There is β¬οΈ survival with plasma exchange or transfusion alone
because 1οΈβ£ the effect is transient
and 2οΈβ£ it doesnβt address the underlying driver
π In this retrospective studyπ cancer-directed therapy increased survival
𧡠5/6
because 1οΈβ£ the effect is transient
and 2οΈβ£ it doesnβt address the underlying driver
π In this retrospective studyπ cancer-directed therapy increased survival
𧡠5/6
Key takeaways:
π Cancer can directly cause a thrombotic microangiopathy (TMA)
π€― Cancer-associated TMA has a 1-month mortality of ~50%
π Cancer-directed therapy β¬οΈ overall survival
𧡠6/end
π Cancer can directly cause a thrombotic microangiopathy (TMA)
π€― Cancer-associated TMA has a 1-month mortality of ~50%
π Cancer-directed therapy β¬οΈ overall survival
𧡠6/end
Thanks for sticking around- I hope you learned something new!
Thank you @myelomatic for the review π
Thank you @myelomatic for the review π
For a deeper dive, full articles are below-
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
and images from (and adapted for this case)-
nejm.org
ahajournals.org
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
and images from (and adapted for this case)-
nejm.org
ahajournals.org
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