Treatment of the underlying malignancy is the most effective therapy for patients with microangiopathic hemolytic anemia. Although some physicians advocate the administration of heparin, the benefits of this therapy have not been conclusively demonstrated. Unlike microangiopathic hemolytic anemia, however, hemolytic-uremic syndrome may occur in patients without evidence of active disease. It is most commonly observed after chemotherapy with mitomycin but also is seen after treatment with bleomycin, cisplatin, dacarbazine, fluorouracil, lomustine, vinca alkaloids, and high-dose chemotherapy with autologous stem cell support. In one series, the syndrome developed in approximately four percent of mitomycin-treated patients.
Mortality is high, and no consistently effective therapy is available.
In one series, the use of extracorporeal immunoadsorption of plasma produced improvement in 45 percent of treated patients. Case reports of successful treatment with plasmapheresis and steroids also have been reported. In one series, the 48-hour mortality resulting from untreated Pseudomonas bacteremia in neutropenic patients was 70 percent. Factors other than neutropenia also place patients with cancer at increased risk for infection. Such factors include deficient phagocytic function secondary to cytotoxic therapy, the breakdown of skin and mucosal barriers secondary to chemotherapy, the presence of vascular access devices, and the high frequency of invasive procedures.