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

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.