MICRO-ANGIOPATHIC HEMOLYTIC-ANEMIA, RENAL-FAILURE, AND NON-CARDIOGENIC PULMONARY-EDEMA - A CHEMOTHERAPY-INDUCED SYNDROME

  • 1 January 1983
    • journal article
    • research article
    • Vol. 67  (5) , 429-434
Abstract
Following gastrectomy for locally advanced adenocarcinomas, 3 patients developed microangiopathic hemolytic anemia and renal failure shortly after completing courses of adjuvant chemotherapy with mitomycin and 5-fluorouracil. These complications progressed despite cessation of chemotherapy, and all 3 patients died of noncardiogenic pulmonary edema precipitated in 2 cases by blood transfusions. At autopsy, 2 patients had no residual carcinoma and all had a diffuse microangiopathy involving mainly the kidneys and lungs. There was intimal hyperplasia of many arterioles sometimes associated with complete occlusion of the lumen, prominent nuclear atypia in many capillary cells, and numerous capillary fibrin thrombi. Direct immunofluorescence studies revealed extensive fibrinogen-fibrin deposits in the vascular lesions. Chemotherapy-induced microangiopathic hemolytic anemia and renal failure may predispose to fatal episodes of noncardiogenic pulmonary edema that can be triggered by blood transfusions.