# Gemcitabine-Induced Thrombotic Microangiopathy in a Patient With Metastatic Pancreatic Cancer: A Case Report

## TL;DR

A 65-year-old woman with pancreatic cancer developed a rare blood disorder after gemcitabine treatment, which was managed with complement-inhibiting drugs.

## Contribution

This case report documents the successful use of complement inhibitors for treating gemcitabine-induced thrombotic microangiopathy.

## Key findings

- The patient developed acute kidney injury, hemolytic anemia, and thrombocytopenia consistent with GiTMA.
- Treatment with eculizumab and later ravulizumab improved the patient's condition by inhibiting the complement cascade.
- The case emphasizes the importance of early recognition and targeted therapy for GiTMA.

## Abstract

Thrombotic microangiopathies (TMA) are potentially life-threatening conditions caused by small-vessel platelet thrombi. Gemcitabine has been reported to induce TMA. Early detection and treatment of gemcitabine-induced TMA (GiTMA) are important to improve overall mortality. This case details a 65-year-old female with metastatic pancreatic acinar cell carcinoma who was treated with gemcitabine. The patient presented with acute kidney injury, hemolytic anemia (requiring transfusion), and thrombocytopenia. She underwent a renal biopsy, which was consistent with thrombotic microangiopathy in the subacute to chronic phase. The patient was initially treated with eculizumab, followed by a transition to ravulizumab due to the latter's less frequent dosing. Eculizumab and ravulizumab are both monoclonal antibodies targeting complement protein C5, subsequently inhibiting the terminal complement cascade and reducing inflammation and tissue injury. This case highlights the importance of recognizing GiTMA and discusses the use of complement inhibitors in its management.