PO65 | OVARIC CANCER PRESENTING WITH COLD-AGGLUTININ MEDIATED HEMOLYTIC ANEMIA, PULMONARY THROMBOEMBOLISM AND DEEP VEIN THROMBOSIS

R. Cannas | Hemostasis and thrombosis Center, Ospedale Santissima Trinità, ASL Cagliari, Italy

Background. CAS (cold-agglutinin syndrome) is rarely idiopathic, while it most frequently is secondary to other processes like infections and lymphoproliferative disorders, although an association with solid tumors has also been described. CAS is also associated with an increased risk of venous thrombosis and pulmonary embolism, linked both to the active hemolysis and the glucocorticoid administration.

Methods. We describe the case of a 54-year-old woman with a history of uterine fibromyomatosis, ovarian cystic lesions, renal lithiasis, and an autoimmune setting (Hashimoto’s thyroiditis and Raynaud’s phenomenon) who presented with severe autoimmune hemolytic anemia (AIHA). Serum studies revealed the presence of polyclonal cold antibodies in a CAS. Prednisone 50 mg/day per os was started, prompting a moderate improvement of hemoglobin and—due to the onset of increased fatigue and shortness of breath—a contrast-enhanced computer tomography (CT) of the chest was performed, revealing bilateral pulmonary embolism. Ultrasonography study (US) confirmed suspected deep vein thrombosis. Apixaban 5 mg twice a day was administered while the patient underwent an extensive workup to identify provoking etiology, including serum Ca-19.9 and Ca-15.3 evaluations. A pelvic MRI to reevaluate the known uterine fibromyomatosis showed several heterogeneous mass lesions arising from the right ovary with regional lymph node involvement and bladder compression. Histological findings from hystero-annessiectomy and omentectomy confirmed a primary ovarian neoplasm. Chemotherapy with carboplatin and paclitaxel was started, but it was immediately complicated by severe anemia, and the patient was transfused.

Results. A new chest CT showed complete resolution of the pulmonary embolism, while a US only showed partial resolution of deep vein thrombosis, suggesting the therapy prosecution with apixaban.

Conclusions. While AIHA is a known paraneoplastic syndrome of hematologic malignancies, this case report suggests that it may also be a paraneoplastic syndrome for solid tumors, particularly in association with pulmonary thromboembolism. Even in case of complete imaging resolution, venous thromboembolism prophylaxis for patients with marked hemolysis should be considered.