SHM Converge Scientific Abstract ePoster Gallery-The Deadly Double Jeopardy: Thrombotic Microangiopathy and Bone Marrow Metastasis in Mucinous Lung Adenocarcinoma

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This case describes a 50-year-old woman with stage IV metastatic mucinous lung adenocarcinoma who developed severe anemia, refractory thrombocytopenia, and hemorrhagic shock after treatment with pembrolizumab, pemetrexed, carboplatin, and radiation. Despite aggressive supportive care, including multiple blood and platelet transfusions, high-dose steroids, IVIG, and romiplostim, she remained profoundly cytopenic and later developed melena, suggesting thrombotic microangiopathy (TMA).<br /><br />Laboratory findings supported microangiopathic hemolytic anemia: hemoglobin 4.0 g/dL, platelets 13,000/µL, elevated LDH, low haptoglobin, elevated indirect bilirubin, and schistocytes on peripheral smear. Because the cause of the hemolysis and cytopenias was unclear, a bone marrow biopsy was performed and revealed metastatic adenocarcinoma with mucinous features, confirming cancer-associated TMA. Immunohistochemical staining supported the diagnosis.<br /><br />The report emphasizes that TMA is a rare but life-threatening complication of solid tumors, especially mucin-secreting cancers such as lung, gastric, breast, and prostate cancers. It can result from the malignancy itself or from cancer-directed therapies. Clinically, it presents with the combination of microangiopathic hemolytic anemia and thrombocytopenia and must be distinguished from TTP, DIC, and atypical HUS. When hemolysis is unexplained, bone marrow evaluation may be essential.<br /><br />After the diagnosis, chemotherapy was restarted, but the patient’s course worsened due to bacteremia and ongoing severe cytopenias. Her decline was felt to reflect both advanced cancer and refractory TMA. Because treatment options for cancer-associated TMA are limited and prognosis is poor, she was ultimately transitioned to comfort-focused care.<br /><br />The key lesson is that cancer-associated TMA should be considered in patients with unexplained hemolytic anemia and thrombocytopenia, and early recognition is crucial for diagnosis and management.

Asset Subtitle

Ashley Bass

Meta Tag

Author List Ashley Bass, Dena Payne, Khedr Salwa, Sonali Harchandani, Srividhya Lakshmanan

Category Clinical Vignettes

Concept Cancer-Associated Thrombotic Microangiopathy

Concept Microangiopathic Hemolytic Anemia

Concept Thrombocytopenia

Concept Schistocytes

Concept Thrombotic Microangiopathy

Distinguished Non-Finalist

Presenter Organization UMass Chan Medical School

Presenting Author Ashley Bass

Track Adult

Keywords

cancer-associated TMA

microangiopathic hemolytic anemia

thrombocytopenia

metastatic mucinous lung adenocarcinoma

pembrolizumab

bone marrow biopsy

schistocytes

hemorrhagic shock

thrombotic microangiopathy

solid tumor complications

Cancer-Associated Thrombotic Microangiopathy

Microangiopathic Hemolytic Anemia

Thrombocytopenia

Schistocytes

Thrombotic Microangiopathy