Abstract
We reported a case of two different episodes of critical coagulopathy in a single patient with metastatic prostate cancer (mPC). The patient initially visited the emergency room with a huge left retroperitoneal hematoma, high serum prostate-specific antigen level, and signs of acute disseminated intravenous coagulation (DIC) from mPC. With blood product replacement and anti-androgen therapy, the DIC-related symptoms and signs were relieved. During the followup, he was treated with docetaxel chemotherapy for hormone refractory PC. Four years later, he visited the emergency room again with relapsed coagulopathy and severe anemia that were not replaced with blood products. The laboratory findings were consistent with thrombotic thrombocytopenic purpura rather than DIC. A satisfactory recovery was achieved with a new cycle of docetaxel chemotherapy. Differentiation of the coagulopathies in PC is difficult; therefore, we describe the different features of two overlapping coagulopathies, which will be helpful in deciding on urgent treatment.
REFERENCES
1. de la Fouchardière C, Flechon A, Droz JP. Coagulopathy in prostate cancer. Neth J Med. 2003; 61:347–54.
2. Doll DC, Kerr DM, Greenberg BR. Acute gastrointestinal bleeding as the presenting manifestation of prostate cancer. Cancer. 1986; 58:1374–7.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Pinto F, Brescia A, Sacco E, Volpe A, Gardi M, Gulino G, et al. Disseminated intravascular coagulation secondary to metastatic prostate cancer: case report and review of the literature. Arch Ital Urol Androl. 2009; 81:212–4.
4. Park YA, Waldrum MR, Marques MB. Platelet count and prothrombin time help distinguish thrombotic thrombocytopenic purpura-hemolytic uremic syndrome from disseminated intravascular coagulation in adults. Am J Clin Pathol. 2010; 133:460–5.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5. Caramello V, Dovio A, Caraci P, Berruti A, Angeli A. Thrombotic thrombocytopenic purpura in advanced prostate cancer: case report and published work review. Int J Urol. 2007; 14:150–2.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6. Marcoullis G, Abebe L, Jain D, Talusan R, Bhagwati N, Wiernik PH. Microangiopathic hemolysis refractory to plasmapheresis responding to docetaxel and cisplatin: a case report. Med Oncol. 2002; 19:189–92.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7. Labelle CA, Kitchens CS. Disseminated intravascular coagulation: treat the cause, not the lab values. Cleve Clin J Med. 2005; 72:377–8.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
8. Rizzo C, Rizzo S, Scirè E, Di Bona D, Ingrassia C, Franco G, et al. Thrombotic thrombocytopenic purpura: a review of the literature in the light of our experience with plasma exchange. Blood Transfus. 2012; 10:521–32.
Fig. 1.
(A) Computed tomography scan at the 1st episode of coagulopathy demonstrated left retroperitoneal hematoma with contrast medium extravasation and multiple lymph node enlargements around aorta and inferior vena cava. (B) Radio-nucleotide bone scan revealed multiple bone metastases at the 1st episode of coagulopathy. Bone scan at the 2nd episode showed more aggravated bone metastatic lesions than the previous episodes. (C) Clinical course and the levels of serum PSA during the follow up. Arrows for docetaxel chemotherapy, PSA, and MAB. PSA: prostate-specific antigen, MAB: maximal androgen blockade, Lt: left, Rt: right.
![kjutii-10-53f1.tif](/upload/SynapseXML/0216kjutii/thumb/kjutii-10-53f1.gif)
Table 1.
Laboratory findings between the coagulatory episodes