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Review
. 2022 Oct;30(10):8599-8609.
doi: 10.1007/s00520-022-06935-5. Epub 2022 May 12.

Thrombotic microangiopathy (TMA) in adult patients with solid tumors: a challenging complication in the era of emerging anticancer therapies

Carme Font  1 , Marta García de Herreros  2 , Nikolaos Tsoukalas  3 , Norman Brito-Dellan  4 , Francis Espósito  2 , Carmen Escalante  5 , Thein Hlaing Oo  6 ; MASCC Hemostasis Study Group
Affiliations
Review

Thrombotic microangiopathy (TMA) in adult patients with solid tumors: a challenging complication in the era of emerging anticancer therapies

Carme Font et al. Support Care Cancer. 2022 Oct.

Abstract

Thrombotic microangiopathy (TMA) is a syndrome that encompasses a group of disorders defined by the presence of endothelial damage leading to abnormal activation of coagulation, microangiopathic hemolytic anemia and thrombocytopenia, occlusive (micro)vascular dysfunction, and organ damage. TMA may occur in patients with malignancy as a manifestation of cancer-related coagulopathy itself or tumor-induced TMA (Ti-TMA) as a paraneoplastic uncommon manifestation of Trousseau syndrome. TMA can also be triggered by other overlapping conditions such as infections or more frequently as an adverse effect of anticancer drugs (drug-induced TMA or Di-TMA) due to direct dose-dependent toxicity or a drug-dependent antibody reaction. The clinical spectrum of TMA may vary widely from asymptomatic abnormal laboratory tests to acute severe potentially life-threatening forms due to massive microvascular occlusion. While TMA is a rare condition, its incidence may progressively increase within the context of the great development of anticancer drugs and the emerging scenarios in supportive care in cancer. The objective of the present narrative review is to provide a general perspective of the main causes, the key work-up clues that allow clinicians to diagnose and manage TMA in patients with solid tumors who develop anemia and thrombocytopenia due to frequent overlapping causes.

Keywords: Cancer-associated coagulopathy; Cancer-associated thrombocytopenia; Thrombotic microangiopathy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Work-up for diagnosis and management of patients with solid tumors and thrombotic microangiopathy
See this image and copyright information in PMC

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