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A case of acute pancreatitis-induced microangiopathic hemolytic anemia with thrombocytopenia
Kevin M Hill1,2, Danielle Moorman3,4, Jonathan Mack3,5,4
1Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. kevhill@toh.ca.
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.
Insights
Microangiopathic hemolytic anemia and thrombocytopenia (MAHA-T) is a rare complication of acute pancreatitis. This case report suggests therapeutic plasma exchange (TPE) may stabilize MAHA-T, even with normal ADAMTS13 levels, warranting further investigation.
Area of Science:
- Internal Medicine
- Hematology
- Gastroenterology
Background:
- Microangiopathic hemolytic anemia and thrombocytopenia (MAHA-T) is a rare but serious complication of acute pancreatitis (AP).
- The optimal management and natural history of AP-induced MAHA-T remain poorly understood.
- Therapeutic plasma exchange (TPE) is frequently employed, but its precise role is unclear.
Observation:
- A case of acute pancreatitis leading to MAHA-T with end-organ dysfunction and a normal ADAMTS13 level is presented.
- The patient's condition, blood counts, and hemolytic markers stabilized after three TPE sessions.
- Clinical improvement persisted even after TPE was discontinued.
Findings:
- Early initiation of TPE is associated with good outcomes in AP-induced MAHA-T.
- The patient demonstrated stabilization and improvement following TPE, despite a normal ADAMTS13 level.
- The value of TPE in altering the natural course of AP-induced MAHA-T requires further elucidation.
Implications:
- This case highlights the potential benefit of TPE in managing acute pancreatitis-associated MAHA-T.
- Further research is needed to clarify the role of ADAMTS13 testing in guiding treatment decisions.
- Understanding the long-term impact and optimal duration of TPE is crucial for clinical practice.
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