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Gemcitabine TMA — SCE Medical Oncology MCQ

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HardOncological EmergenciesGemcitabine TMASCE Medical Oncology

A 65-year-old woman with metastatic breast cancer develops acute confusion, petechiae and a microangiopathic haemolytic anaemia (schistocytes on blood film, low platelets, elevated LDH, low haptoglobin) while on gemcitabine. What is the most likely diagnosis?

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Correct answer: E — Gemcitabine-associated thrombotic microangiopathy with renal and neurological involvement

Gemcitabine can cause drug-associated thrombotic microangiopathy with MAHA, thrombocytopenia, renal injury and neurological involvement. Gemcitabine-associated disseminated intravascular coagulation with consumptive coagulopathy: normal coagulation tests argue against DIC. Gemcitabine-associated immune thrombocytopenia with isolated platelet destruction: schistocytes and biochemical haemolysis show a microangiopathy rather than isolated ITP. Gemcitabine-associated warm autoimmune haemolysis with positive direct antiglobulin testing: warm AIHA produces spherocytes and DAT positivity rather than MAHA. Gemcitabine-associated megaloblastic anaemia with ineffective erythropoiesis: cobalamin-pattern marrow disease does not explain thrombocytopenic microangiopathy.

Reference: Gemcitabine 1000 mg UK summary of product characteristics (Current UK SmPC, accessed July 2026): https://www.medicines.org.uk/emc/product/3119/smpc; British Society for Haematology guideline for TTP and thrombotic microangiopathies (Published August 2023; current BSH guidance): https://b-s-h.org.uk/guidelines/guidelines/diagnosis-and-management-of-thrombotic-thrombocytopenic-purpura-and-thrombotic-microangiopathies