Carboplatin‐induced immune hemolytic anemia

Marani, T. M.; Trich, M. B.; Armstrong, Katy; Ness, Paul M.; Owen‐Smith, Jason; Minniti, Caterina P.; Sandler, S. Gerald

doi:10.1046/j.1537-2995.1996.36111297091748.x

Cited by 38 publications

(36 citation statements)

References 4 publications

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“…It is generally assumed that these drug-dependent antibodies are specific for the drug itself, linked covalently to red-cell membrane proteins, i.e., they are classic hapten-specific antibodies [21]. Similar findings have been observed with serum from patients who developed immune hemolysis after treatment with various organoplatins, i.e., the antibodies reacted with red cells pre-incubated with drug at high concentration (up to 1.0 mg/mL) [8,10,11,14]. These observations were consistent with the possibility that the antibodies were specific for drug complexed with one or more red-cell membrane proteins, possibly acting as a hapten.…”

Section: Discussionmentioning

confidence: 55%

Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin

et al. 2006

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Thrombocytopenia developing in the course of chemotherapy for malignant disease is usually attributed to drug-induced marrow suppression and/or marrow replacement by tumor. We describe two patients who developed severe thrombocytopenia and hemorrhagic symptoms while being treated with oxaliplatin, 5-fluorouracil, and leukovorin for metastatic colon cancer in whom platelet destruction appears to have been caused by oxaliplatin-dependent antibodies specific for the platelet glycoprotein IIb/IIIa complex (a IIb /b 3 integrin). Drug-induced immune thrombocytopenia (DITP) should be considered in patients who experience a sudden, isolated drop in platelet levels while being treated with chemotherapeutic agents, especially when adequate numbers of megakaryocytes are present in the bone marrow. Am.

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Section: Discussionmentioning

confidence: 55%

Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin

et al. 2006

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“…Antibody development and hemolysis may occur any time during drug treatment, from immediately after initiation to many months later (1,9). Numerous beta-lactamase inhibitors have been implicated as triggers of acute antibody-mediated hemolysis (1).…”

Section: Discussionmentioning

confidence: 99%

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

2015

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A 76-year-old woman treated with meropenem developed intravascular hemolytic attacks. A direct antiglobulin test was positive for C3d and IgG, and drug-dependent antibody testing indicated that the antibodies were indeed drug-dependent and reacted with drug-treated RBCs and RBCs in the presence of the drug. To our knowledge, this is the first reported case in which the causative antibodies related to meropenem were identified. This case highlights the importance of maintaining a high level of suspicion for drug-induced immune hemolytic anemia in patients with explained hemolysis as well as conducting specialized serologic testing.

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“…Haemolytic anaemia has previously been reported with cisplatin (Levi et al, 1981) and carboplatin (Marani et al, 1996), as well as oxaliplatin. In contrast to the previous case report of oxaliplatinmediated haemolytic anaemia, our patient recovered with supportive treatment.…”

Section: Sirmentioning

confidence: 92%

“…He made a complete clinical recovery, with a platelet count of 122 000 µl Ϫ1 and a hemoglobin of 109 g l Ϫ1 2 weeks later while tapering off the steroids. In the month since this episode he has had continued disease stability, but he has not been re-challenged with oxaliplatin.Haemolytic anaemia has previously been reported with cisplatin (Levi et al, 1981) and carboplatin (Marani et al, 1996), as well as oxaliplatin. In contrast to the previous case report of oxaliplatinmediated haemolytic anaemia, our patient recovered with supportive treatment.…”

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confidence: 92%

Oxaliplatin-induced Evan’s syndrome

et al. 2001

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Sir,Oxaliplatin is a third-generation platinum compound with activity in advanced colorectal cancer. It is available in several European countries, but remains investigational in North America. Its safety profile compares favourably with the other platinum-based agents, cisplatin and carboplatin, and consists mostly of peripheral neuropathy and mild thrombocytopenia. However, there has been one previous report in the literature of fatal haemolytic anaemia caused by oxaliplatin (Desrame et al, 1999). Here we report immune-mediated thrombocytopenia and concurrent haemolytic anaemia (Evan's syndrome) that developed during oxaliplatin infusion.In November of 1999, a 56-year-old man with a 2-year history of colon cancer metastatic to liver and lung, who had progressed on first-line 5-FU and leucovorin as well as second-line irinotecan, was enrolled on a Phase II study at the Dana-Farber Cancer Institute. Treatment consisted of oxaliplatin 85 mg/m 2 by bolus infusion over 2 hours, followed by 500 mg/m 2 of leucovorin also infused over 2 hours, 5-FU 400 mg/m 2 by rapid venous infusion, and then 5-FU 2400 mg/m 2 by continuous infusion with a portable pump over 46 hours. Treatment was repeated every 2 weeks. The patient had stable disease on this regimen between November 1999 and July 2000.In July, the patient came for a routine treatment with a platelet count of 99 000 µl -1 immediately prior to infusion. During the leucovorin infusion, approximately 5 hours after the baseline bloodwork was drawn and the oxaliplatin infusion initiated, he began feeling unwell and his gums began to bleed. He subsequently developed purpura on his oral mucosa and eyelids, haematuria and haematochezia. A repeat platelet count was 6000 µl -1 .He remained haemodynamically stable throughout, and initial haemoglobin and INR were normal. He was admitted to hospital for platelet transfusion and supportive care, but quickly also developed anaemia with a drop in his haemoglobin from 108 to 78 g l -1. Peripheral smear confirmed the decreased platelets, with a left shift in red cell morphology. There was anisocytosis and polychromasia, with a high RDW of 17.3 and increased reticulocytes at 4.7%. Bilirubin rose to 4.4 mg dl -1 , with only 1.4 mg dl -1 being direct, and the LDH increased to 2148 U l -1. Laboratory testing indicated a warm antibody, with a positive direct Coomb's test with polyspecific IgG. There was no anti-C3 antibody, and the eluate reacted with all cells. His INR also rose transiently to 2.4. Clotting factor levels and fibrinogen were normal, although Fibrin Split Products were elevated at 8 µg ml -1 . Screening for heparininduced thrombocytopenia and thrombosis (HITT) was negative.The patient was treated with prednisone 75 mg orally per day, with stabilization of his blood indices over the course of 3 days after receiving a total of 4 units of single donor platelets, 3 units of packed red blood cells, and 4 units of fresh frozen plasma. He made a complete clinical recovery, with a platelet count of 122 000 µl Ϫ1 and a hemoglobin of...

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Carboplatin‐induced immune hemolytic anemia

Cited by 38 publications

References 4 publications

Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin

Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin

Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

Oxaliplatin-induced Evan’s syndrome

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