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Abstract：
Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening thrombotic microangiopathy (TMA) that needs prompt identification and treatment. Disseminated malignancy-related TMA can potentially be misdiagnosed as TTP, and patients may be inappropriately subjected to therapeutic plasma exchange (TPE) with serious implications. Likewise, the presence of a concurrent cancer diagnosis in a patient with microangiopathic hemolytic anemia and thrombocytopenia may lead to suspicion of disseminated malignancy as the cause, delaying the TPE with serious outcomes. Testing for ADAMTS13 activity is diagnostic of TTP, but the results may take time. This poses a diagnostic and therapeutic dilemma that includes weighing the benefits of TPE for treating TTP and cancer treatment. We describe a rare case of immune-mediated TTP in a patient concurrently diagnosed with metastatic renal cell cancer. To our knowledge, this is the first case of TTP reported in patients with metastatic renal cell carcinoma (RCC) in a non-treatment-naive patient.
摘要：
血栓性血小板减少性紫癜（TTP）是一种可能危及生命的血栓性微血管病（TMA），需要及时识别和治疗。播散性恶性肿瘤相关的TMA可能被误诊为TTP，患者可能会不适当地接受治疗性血浆置换（TPE），并产生严重影响。同样，在患有微血管病性溶血性贫血和血小板减少症的患者中，并发癌症诊断的存在可能导致怀疑播散性恶性肿瘤的原因，延迟TPE与严重的结果。ADAMTS13活性测试是TTP的诊断，但结果可能需要时间。这造成了诊断和治疗困境,包括权衡TPE治疗TTP和癌症治疗的益处。我们描述了同时诊断为转移性肾细胞癌的患者中免疫介导的TTP的罕见病例。据我们所知,这是在未接受过治疗的转移性肾细胞癌(RCC)患者中报告的第一例TTP.
