Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 13, Number 6, June 2022, pages 274-280

Carfilzomib-Induced Thrombotic Microangiopathy: Focus on Pathogenesis


Figure 1.
Figure 1. Patient timeline reflecting change in creatinine related to therapeutic interventions. TPE: therapeutic plasma exchange.
Figure 2.
Figure 2. Patient timeline reflecting change in platelets related to therapeutic interventions. TPE: therapeutic plasma exchange.


Table 1. Laboratory Values on Presentation
AnalyteValueReference range
White blood cells11,000/µL4,400 - 10,700/µL
Hemoglobin11.6 g/dL12.0 - 15.5 g/dL
Mean corpuscular volume92 fL81 - 97 fL
Platelet count2,000/µL150,000 - 400,000/µL
Blood urea nitrogen29 mg/dL7 - 26 mg/dL
Serum creatinine1.3 mg/dL0.50 - 1.3 mg/dL
Total bilirubin4.2 mg/dL0.2 - 1.0 mg/dL
Direct bilirubin0.4 mg/dL0.0 - 0.5 mg/dL
Albumin3.0 g/dL3.4 - 5.0 g/dL
Prothrombin time10.9 s12.1 - 14.8 s
International normalized ratio1.1
Haptoglobin< 8 mg/dL30 - 200 mg/dL
Direct antibody testNegative
Lactate dehydrogenase1,757 U/L125 - 243 U/L
Fibrinogen368 mg/dL200 - 400 mg/dL
D-dimer5.63 mg/L0.17 - 0.5 mg/L


Table 2. Hemolytic Indices During Hospital Admission
AnalyteBefore presentationAt presentationPeak abnormal valueTwo weeks after presentation (discharge)
Hemoglobin (g/dL) (day 3)7.3
Platelets (/µL)251,0002,0002,000307,000
Serum creatinine (mg/dL) (day 8)1.8
Lactate dehydrogenase (U/L)1631,7571,757433
Total bilirubin (mg/dL)