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Mitomycin-Induced Thrombotic Thrombocytopenic Purpura Treated Successfully With Plasmapheresis and Steroid: A Case
Misbahuddin Khaja1, Zaheer A Qureshi2, Sameer Kandhi3
1Internal Medicine/Pulmonary Critical Care, Icahn School of Medicine at Mount Sinai/BronxCare Health System, New York City, USA.
Abstract:
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) caused by severely reduced ADAMTS13 or the von Willebrand factor-cleaving protease (VWFCP) enzyme resulting in low platelet and red blood cell counts along with severe renal, cardiac, and neurological dysfunction. Plasmapheresis is the treatment of choice. Mitomycin, a widely used chemotherapeutic agent for gastrointestinal (GI) cancers anal and breast cancers, has been reported to occasionally cause severe TTP and hemolytic uremic syndrome (HUS) cases. Here, we present a case of a 57-year-old African American transgender patient who presented with worsening kidney function, thrombocytopenia, and anemia following mitomycin therapy for her anal squamous cell carcinoma. Peripheral smear showed numerous schistocytes, and the patient was diagnosed with TTP because of low ADAMTS13 levels. The patient was started on plasmapheresis and steroid with ultimate improvement in condition. TTP is a rare condition that can be idiopathic or acquired. Further research is required to assess the complexity of the underlying mechanism. Early diagnosis and aggressive management often lead to a favorable outcome.
Insights
Thrombotic thrombocytopenic purpura (TTP), a rare blood disorder, can be triggered by mitomycin chemotherapy. Early diagnosis and plasmapheresis treatment are crucial for patient recovery.
Area of Science:
- Hematology
- Oncology
- Nephrology
Background:
- Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage.
- Severe deficiency of ADAMTS13 activity is the primary cause of TTP.
- Mitomycin, a chemotherapy agent, is a known, albeit rare, cause of TTP and hemolytic uremic syndrome (HUS).
Observation:
- A 57-year-old African American transgender patient developed TTP following mitomycin therapy for anal squamous cell carcinoma.
- Clinical presentation included worsening kidney function, thrombocytopenia, and anemia.
- Peripheral blood smear revealed schistocytes, indicative of microangiopathic hemolysis.
Findings:
- Low ADAMTS13 levels confirmed the diagnosis of TTP.
- The patient responded well to plasmapheresis and steroid treatment.
- This case highlights mitomycin-induced TTP in a transgender patient.
Implications:
- Early recognition and prompt treatment of TTP are essential for favorable outcomes.
- Further research is needed to elucidate the complex mechanisms underlying acquired TTP.
- Awareness of mitomycin's potential to induce TTP is critical for oncologists and hematologists.
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