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Gemcitabine-Induced Thrombotic Microangiopathy in a Patient With Metastatic Pancreatic Cancer: A Case Report

Year: 2025

Type: article

Abstract: Thrombotic microangiopathies (TMA) are potentially life-threatening conditions caused by small-vessel platelet thrombi. Gemcitabine has been reported to induce TMA. Early detection and treatment of gemcitabine-induced TMA (GiTMA) are important to improve overall mortality. This case details a 65-year-old female with metastatic pancreatic acinar cell carcinoma who was treated with gemcitabine. The patient presented with acute kidney injury, hemolytic anemia (requiring transfusion), and thrombocytopenia. She underwent a renal biopsy, which was consistent with thrombotic microangiopathy in the subacute to chronic phase. The patient was initially treated with eculizumab, followed by a transition to ravulizumab due to the latter's less frequent dosing. Eculizumab and ravulizumab are both monoclonal antibodies targeting complement protein C5, subsequently inhibiting the terminal complement cascade and reducing inflammation and tissue injury. This case highlights the importance of recognizing GiTMA and discusses the use of complement inhibitors in its management.

Source: Cureus

DOI: 10.7759/cureus.95175

Author: Jacqueline Young

Institution: Moffitt Cancer Center

Language: English

Topic: Complement system in diseases

Subfield: Immunology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Moffitt Cancer Center