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A case of acute pancreatitis-induced microangiopathic hemolytic anemia with thrombocytopenia

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Abstract

Microangiopathic hemolytic anemia and thrombocytopenia (MAHA-T) is a rare complication of acute pancreatitis (AP). Treatment with therapeutic plasma exchange (TPE) is used at many centers. The natural history of this disease is not well understood. We report a case of acute pancreatitis induced MAHA-T with end organ dysfunction and a normal ADAMTS13 level. Following three TPEs, the patient’s clinical status, blood counts and hemolytic markers stabilized. Improvement occurred even after TPE was discontinued. The optimal management of AP-induced MAHA-T is poorly understood. Many centres are reporting good outcomes with the early initiation of TPE. MAHA-T associated with acute pancreatitis is often treated with early initiation of TPE. However, the value of TPE in altering the natural history of the condition is not well understood. Further study is required to understand the role of ADAMTS13 testing to guide treatment, and the role of TPE in management.

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Fig. 1

Abbreviations

ADAMTS13 :

A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13

AP :

Acute pancreatitis

MAHA :

Microangiopathic hemolytic anemia

MAHA-T :

Microangiopathic hemolytic anemia and thrombocytopenia

PAD :

Post-admission day

TPE :

Therapeutic plasma exchange

TTP :

Thrombotic thrombocytopenic purpura

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Authors and Affiliations

  1. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Kevin M. Hill, Danielle Moorman, Jonathan Mack, Carol Gonsalves & Roy Khalife

  2. Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada

    Jonathan Mack, Carol Gonsalves & Roy Khalife

  3. Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada

    Kevin M. Hill, Danielle Moorman, Jonathan Mack, Carol Gonsalves & Roy Khalife

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  1. Kevin M. Hill
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Correspondence to Kevin M. Hill.

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Hill, K.M., Moorman, D., Mack, J. et al. A case of acute pancreatitis-induced microangiopathic hemolytic anemia with thrombocytopenia. J Thromb Thrombolysis 49, 159–163 (2020). https://doi.org/10.1007/s11239-019-01946-2

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