Monoclonal gammopathy of thrombotic/thrombocytopenic significance

Letter to Blood| April 6, 2023 Monoclonal gammopathy of thrombotic/thrombocytopenic significance Adam J. Kanack, Adam J. Kanack 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Jordan K. Schaefer, Jordan K. Schaefer 2Department of Medicine, University of Michigan, Ann Arbor, MI https://orcid.org/0000-0002-7166-386X Search for other works by this author on: This Site PubMed Google Scholar Meera Sridharan, Meera Sridharan 3Department of Medicine, Mayo Clinic, Rochester, MN https://orcid.org/0000-0001-7225-8228 Search for other works by this author on: This Site PubMed Google Scholar Noah P. Splinter, Noah P. Splinter 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Mindy C. Kohlhagen, Mindy C. Kohlhagen 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Bandana Singh, Bandana Singh 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Silvana B. De Lorenzo, Silvana B. De Lorenzo 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Emily E. Mauch, Emily E. Mauch 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Maen A. Hussein, Maen A. Hussein 4Florida Cancer Specialists, Orlando, FL Search for other works by this author on: This Site PubMed Google Scholar Marwan Shaikh, Marwan Shaikh 5Department of Medicine, Mayo Clinic, Jacksonville, FL Search for other works by this author on: This Site PubMed Google Scholar Shaji Kumar, Shaji Kumar 3Department of Medicine, Mayo Clinic, Rochester, MN https://orcid.org/0000-0001-5392-9284 Search for other works by this author on: This Site PubMed Google Scholar Renren Wen, Renren Wen 6Department of Microbiology and Immunology, Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI https://orcid.org/0000-0003-2420-8212 Search for other works by this author on: This Site PubMed Google Scholar Demin Wang, Demin Wang 6Department of Microbiology and Immunology, Versiti Blood Research Institute and Medical College of Wisconsin, Milwaukee, WI https://orcid.org/0000-0001-5549-3795 Search for other works by this author on: This Site PubMed Google Scholar David Murray, David Murray 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN Search for other works by this author on: This Site PubMed Google Scholar Anand Padmanabhan Anand Padmanabhan 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN https://orcid.org/0000-0003-2519-4377 Search for other works by this author on: This Site PubMed Google Scholar Blood (2023) 141 (14): 1772–1776. https://doi.org/10.1182/blood.2022018797 Article history Submitted: October 19, 2022 Accepted: December 27, 2022 First Edition: January 10, 2023 Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Request Permissions Cite Icon Cite Search Site Citation Adam J. Kanack, Jordan K. Schaefer, Meera Sridharan, Noah P. Splinter, Mindy C. Kohlhagen, Bandana Singh, Silvana B. De Lorenzo, Emily E. Mauch, Maen A. Hussein, Marwan Shaikh, Shaji Kumar, Renren Wen, Demin Wang, David Murray, Anand Padmanabhan; Monoclonal gammopathy of thrombotic/thrombocytopenic significance. Blood 2023; 141 (14): 1772–1776. doi: https://doi.org/10.1182/blood.2022018797 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsBlood Search Subjects: Thrombosis and Hemostasis TO THE EDITOR: Anti–platelet factor 4 (PF4) antibodies have a central role in the pathophysiology of thrombosis and thrombocytopenia in heparin-induced thrombocytopenia (HIT)1,2 and vaccine-induced immune thrombotic thrombocytopenia (VITT).3-7 Here, we present the case of a patient with recurrent thrombosis and thrombocytopenia, secondary to a persistent anti-PF4/polyanion monoclonal antibody due to an underlying neoplastic condition, which we refer to as monoclonal gammopathy of thrombotic/thrombocytopenic significance (MGTS). The implications of these findings for the investigation of unexplained thrombophilia are discussed. A 64-year-old man presented for evaluation of recurrent thrombotic episodes. His medical history included segmental and subsegmental pulmonary emboli, portal vein thrombosis, non-ST elevation myocardial infarction, splenic infarction, and ST elevation myocardial infarction (Figure 1A). Extensive investigations performed did not support a thrombophilia diagnosis (supplemental Table 1 and supplemental Materials; available on the Blood website). His... References 1.Arepally GM, Cines DB. Pathogenesis of heparin-induced thrombocytopenia. Transl Res. 2020;225:131-140.Google ScholarCrossrefSearch ADS PubMed 2.Greinacher A. Heparin-induced thrombocytopenia. N Engl J Med. 2015;373(19):1883-1884.Google Scholar 3.Greinacher A, Selleng K, Palankar R, et al. Insights in ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia. 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