Persistent Thrombocytopenia of an Unexplained Cause in a Patient With Metastatic Renal Cell Carcinoma: A Case Report

Thrombocytopenia is a common complication in patients with solid tumors, particularly renal cell carcinoma (RCC), arising from mechanisms such as chemotherapy, direct tumor invasion, and paraneoplastic syndromes. Managing thrombocytopenia in advanced cancer presents significant challenges, often limiting therapeutic options and impacting patient outcomes. This case report describes a 62-year-old man with metastatic RCC complicated by persistent thrombocytopenia, unresponsive to both conventional treatments and novel therapies. Initially treated with palliative intent using Sunitinib, the patient developed complex symptoms including breathlessness, lymphorrhea, petechial rashes, and generalized weakness. Symptom management in a palliative care setting focused on pain relief with morphine and fentanyl, pleural effusion drainage, magnesium sulfate application for lymphorrhea, and occupational therapy for functional support. Additionally, psychological and spiritual care provided holistic support to the patient and his family. This case underscores the challenges of managing refractory thrombocytopenia in metastatic RCC and highlights the importance of individualized care in palliative settings. While therapeutic interventions were limited by the complexity of the disease, improvements in symptom control and emotional well-being demonstrate the value of a multidisciplinary approach in enhancing the patient's quality of life. This report emphasizes the need for further research into effective strategies for managing malignancy-associated thrombocytopenia.