TITLE:
Gemcitabine-Induced Thrombotic Microangiopathy with Renal Involvemente: A Case Report
AUTHORS:
Flávia Fundora Ramos, Catarina Pinto Silva, Flávia Freitas, Sara Rodrigues
KEYWORDS:
Thrombotic Microangiopathy, Gemcitabine, Acute Kidney Injury, Chemotherapy, Nephrotoxicity
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.14 No.11,
November
6,
2025
ABSTRACT: Introduction: Thrombotic microangiopathy (TMA) is characterized by small vessel occlusion, leading to thrombocytopenia, hemolytic anemia, and organ damage. It is increasingly recognized as a complication of chemotherapy, including gemcitabine, which can induce renal disfunction. Case Report: A 61-year-old man with undifferentiated giant cell carcinoma of the pancreas developed gemcitabine-induced TMA after two months of treatment and a cumulative dose of approximately 6000 mg/m2. Laboratory findings revealed thrombocytopenia, hemolytic anemia, elevated LDH, and progressive renal impairment. A renal ultrasound indicated chronic nephropathy. The diagnosis was confirmed with peripheral schistocytes and the absence of haptoglobin and Coombs positivity. Following discontinuation of gemcitabine, renal function and hematological parameters improved. Discussion: Gemcitabine-induced TMA is an emerging complication in oncological treatments. Its mechanisms likely involve endothelial injury and immune-mediated responses. Early diagnosis and prompt cessation of gemcitabine can mitigate severe renal consequences. Conclusion: Gemcitabine should be considered a potential cause of TMA in cancer patients, especially those with unexplained renal dysfunction, to prevent irreversible kidney damage.