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Resume La microangiopathie thrombotique est une complication rare mais grave du traitement par gemcitabine. Sa prevalence augmente du fait de l’elargissement des indications de cette chimiotherapie. Nous rapportons quatre cas pour lesquels la presentation clinicobiologique est relativement typique, associant hypertension arterielle, proteinurie et augmentation de la creatinine plasmatique. En revanche, la gravite du tableau est variable, necessitant le recours inconstant a une technique d’hemodialyse. Les strategies therapeutiques, outre l’arret systematique de la gemcitabine, ne sont pas consensuelles. Elles ont ete guidees par la gravite du tableau : echanges plasmatiques d’efficacite variable et eculizumab, qui s’est avere efficace lorsqu’il a ete utilise. Il ressort surtout que ce syndrome est compose de signes banals et frequents chez des patients recevant des chimiotherapies, comme les cytopenies et la majoration de la creatinine. Mais ces signes devraient inciter a rechercher d’autres signes plus specifiques, tels qu’une hypertension arterielle, des stigmates d’hemolyse mecanique, une proteinurie ou une hematurie, afin de reconnaitre le plus precocement possible la microangiopathie thrombotique et permettre sa prise en charge rapide, en evitant de nouvelles injections.

Thrombotic microangiopathy is a rare but severe complication of treatment with gemcitabine. Its prevalence increases because gemcitabine's indications are growing. We report four cases, which presented with common clinical and biological manifestations, i.e. high blood pressure, proteinuria and increasing plasmatic creatinine level. However, severity was not similar, hemodialysis was inconstant. There is no consensus on treatment for this condition. Stopping gemcitabine is essential. Treatment was dispensed considering the severity of the presentation: plasma exchange therapy of variable outcome, and eculizumab, which was efficient when used. It's important to note that this syndrome includes common and frequent signs in patients receiving chemotherapies. But they must encourage the research of most specific signs, such as hypertension, mechanic hemolysis signs, proteinuria or hematuria, in order to recognize thrombotic microangiopathy as early as possible to treat it precociously, and to prevent additional gemcitabine injections.