Clin Pediatr Hematol Oncol.  2014 Oct;21(2):140-144. 10.0000/cpho.2014.21.2.140.

A Case of Thrombotic Microangiopathy Following Autologous Stem Cell Transplantation

• Choi JY
• Lee JW
• Ju HY
• Hong CR
• Kim H
• Lee DS
• Kim NH
• Kang HJ
• Park KD
• Shin HY

• KMID: 2279824
• DOI: http://doi.org/10.0000/cpho.2014.21.2.140

Abstract

Transplantation-associated thrombotic microangiopathy (TA-TMA) is an uncommon but devastating complication in patients who undergo hematopoietic stem cell transplantation (SCT). However, the optimal treatment strategy for TA-TMA is unclear. We report a rare case of TA-TMA in a 39-month-old boy who underwent tandem autologous SCT (autoSCT) for high-risk medulloblastoma. TA-TMA developed 64 days after the second autoSCT with microangiopathic hemolytic anemia, fever, renal impairment, acute respiratory distress syndrome and posterior reversible encephalopathy syndrome. The patient recovered after plasmapheresis and methylprednisolone therapy. He had mild to moderate deficiency of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13). The patient's clinical course would suggest that plasmapheresis and methylprednisolone therapy could be a treatment option for TA-TMA. Early intervention is needed to aid the recovery of the patient who is suspected for TA-TMA.

Keyword

Thrombotic microangiopathy; Autologous stem cell transplantation; Plasmapheresis; Pediatrics

MeSH Terms

Anemia, Hemolytic
Child, Preschool
Early Intervention (Education)
Fever
Hematopoietic Stem Cell Transplantation
Humans
Male
Medulloblastoma
Methylprednisolone
Pediatrics
Plasmapheresis
Posterior Leukoencephalopathy Syndrome
Respiratory Distress Syndrome, Adult
Stem Cell Transplantation*
Thrombospondins
Thrombotic Microangiopathies*
Methylprednisolone
Thrombospondins