GPR: 2021 - Week 18

From MGH Learn Pathology

Clinical history

62 yo M with metastatic colon cancer developed altered mental status during a chemotherapy infusion. He was sent to OSH ED, receives multiple transfusions and then is transferred to MGH a few hours later. He is found to be anemic and thrombocytopenic. His type and screen sample upon arrival is shown below.


GPR21-17-a4650a64-a548-4c0f-983b-d198a367a0a9.jpeg


Registered users must be logged in to access the interactive quiz.


GPR21-17-a4650a64-a548-4c0f-983b-d198a367a0a9.jpeg

 
Thrombotic microangiopathy
  • Clot formation in small vessels leads to platelet / fibrinogen consumption with RBC damage
  • Schistocytes seen on peripheral smear
  • Damaged RBCs are cleared through extravascular hemolysis
  • Hemoglobin breakdown products are released into the blood, producing brown jaundiced plasma
 

GPR21-17-b6d4aa9e-7bda-4a6b-ab53-139fe3ac648d.jpeg

 

Chemotherapy marrow suppression

  • Numerous chemotherapy regimens result in suppression of hematopoiesis
  • Often multi-lineage deficiencies
  • No hemolysis, plasma appears yellow (normal)
 

GPR21-17-373e384a-a7ca-4cac-823d-653f413f267d.jpeg

 

ABO mismatch

  • Preformed ABO antibodies (predominantly IgM) react with donor RBCs
  • Fix complement and lead to brisk intravascular hemolysis
  • Serum is bright red from hemoglobin release
  • Urine frequently also bright red (3+ blood, no RBCs seen) from hemoglobin as well
 


  • Dave Justus
  • Adele Tirella
  • Tem Bendapudi

This week's Gross Pathology Roundup was presented by Surya Nagaraja, MD, PhD on Mon, May 03, 2021.