SHM Converge Scientific Abstract ePoster Gallery-Hiding in Plain Sight: An Uncommon Cause of Dyspnea in a Healthy Young Woman

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This case describes a 43-year-old previously healthy woman who presented with dyspnea, fatigue, and severe anemia after several weeks of heavy vaginal bleeding. Her labs showed hemolytic anemia and thrombocytopenia, including low hemoglobin, low platelets, elevated LDH, low haptoglobin, and schistocytes on peripheral smear. Because the PLASMIC score was 6, she was initially treated empirically for thrombotic thrombocytopenic purpura (TTP) with prednisone and plasma exchange.<br /><br />However, ADAMTS13 activity returned at 40%, making TTP unlikely. Further workup revealed a left breast nodule and a T1 vertebral lesion on CT angiography. Additional hematologic studies were unrevealing. Bone marrow biopsy ultimately showed metastatic adenocarcinoma of breast origin, and bone scan demonstrated diffuse osseous metastases with marrow infiltration. The final diagnosis was cancer-related thrombotic microangiopathy (CR-TMA) caused by metastatic breast cancer with marrow carcinomatosis.<br /><br />The discussion highlights that CR-TMA is a rare but serious subtype of thrombotic microangiopathy, accounting for about 5% of TMA cases. It is associated with marrow carcinomatosis and multifocal bone metastases. Although breast cancer has a recognized association with CR-TMA, it remains uncommon. The report emphasizes that CR-TMA can closely mimic TTP, making diagnosis challenging and reinforcing the need to avoid anchoring bias when evaluating undifferentiated TMA.<br /><br />The patient was started on paclitaxel, with improvement in symptoms and blood counts. She remained on chemotherapy approximately eight months later.

Asset Subtitle

William A. White

Meta Tag

Author List Kathryn Addonizio, Patrick Tai, Rahi A. Patel, William A. White

Category Clinical Vignettes

Concept Secondary Thrombotic Microangiopathy

Concept Cytopenia

Concept Hemolysis

Concept Microangiopathic Hemolytic Anemia

Concept Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization UMass Chan Medical School

Presenting Author William A. White

Track Adult

Keywords

cancer-related thrombotic microangiopathy

metastatic breast cancer

thrombotic thrombocytopenic purpura

ADAMTS13 activity

marrow carcinomatosis

hemolytic anemia

thrombocytopenia

bone metastases

plasma exchange

paclitaxel

Secondary Thrombotic Microangiopathy

Cytopenia

Hemolysis

Microangiopathic Hemolytic Anemia

Thrombocytopenia