Disseminated Intravascular Coagulation and Immune Hemolytic Anemia, Possibly Evans Syndrome, After Oxaliplatin and Bevacizumab Infusion for Metastatic Colon Adenocarcinoma: A Case Report and Literature Review

Meng, Lingjin; Romano, Andrew M.; Smith, Elliot; Macik, Gail; Grosh, William W.

doi:10.1016/j.clcc.2014.11.005

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…There are several other case reports showing associations between oxaliplatin and hematologic abnormalities such as immune-mediated hemolytic anemia [5,6], ITP [4,5], and thrombotic thrombocytopenic purpura [7]. However, there are only 3 case reports to date suggesting an association between oxaliplatin and DIC, all described in cases of metastatic colon cancer [9,10,11]. …”

Section: Discussionmentioning

confidence: 98%

“…The second case was identified in a 76-year-old woman with metastatic colon cancer, who experienced bloody emesis, hematochezia, and hematuria during her sixth cycle of oxaliplatin, 4 h into an oxaliplatin and bevacizumab infusion [11]. Her labs were consistent with DIC and AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, it is known to be implicated in hypersensitivity reactions [4], and is less known to be associated with hematologic abnormalities such as immune-mediated hemolytic anemia [5,6], immune thrombocytopenia (ITP) [4,5], and thrombotic thrombocytopenic purpura [7]. To date, there are few reported cases of disseminated intravascular coagulation (DIC) associated with oxaliplatin administration [8,9,10,11]. In this case report, we describe a 71-year-old man with metastatic colon adenocarcinoma and chronic ITP who presented with an acute hypersensitivity reaction followed by DIC and acute kidney injury (AKI) after the infusion of oxaliplatin.…”

Section: Introductionmentioning

confidence: 99%

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Acute Disseminated Intravascular Coagulation after Oxaliplatin Infusion

Waddle

Irvin

Gupta³

et al. 2017

Chemotherapy

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Oxaliplatin is one of the most commonly used drugs for patients with colorectal cancer. It has rarely been associated with disseminated intravascular coagulation (DIC) with only 3 previously reported cases. In all those instances, the patients had started receiving oxaliplatin, developed evidence of DIC during the course of planned treatment, and recovered with supportive care. We report a case of a 71-year-old man with colorectal cancer treated successfully with an oxaliplatin-based regimen who had disease relapse after 3 years. When treated again with oxaliplatin, he developed signs of an acute hypersensitivity reaction, and eventually had signs and symptoms consistent with DIC despite appropriate management. This case is unique in that a DIC reaction evolving from a hypersensitivity reaction occurred after the patient had already tolerated the drug years earlier. It suggests a possible immune-mediated etiology to this rare occurrence that should be kept in mind while utilizing this commonly employed drug.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Disseminated Intravascular Coagulation after Oxaliplatin Infusion

Waddle

Irvin

Gupta³

et al. 2017

Chemotherapy

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“…En sık görülen yan etkileri bulantı, kusma, diyare, nöropati ve kemik iliği baskılanmasıdır. Daha seyrek olarak uzun süreli kullanımında immüntrombositopeni, hemolitik anemi ve yaygın damar içi pıhtılaşma bildirilmiştir (1)(2)(3). İlaca bağlı otoimmün hemolitik anemi (OİHA) nadir görülen, fakat ciddi bir yan etkidir.…”

Section: Introductionunclassified

Oxaliplatin-induced Autoimmune Hemolitic Anemia

Yaşar¹,

Şahin²,

Sağlam³

et al. 2017

Acta Oncol Tur.

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ÖZETOksaliplatin, onkoloji pratiğinde sık kullanılan üçüncü kuşak bir platin analoğudur. En sık görülen yan etkileri arasında bulantı, kusma, diyare, nöropati ve kemik iliği baskılanması yer almaktadır. İmmüntrombositopeni ve immün hemolitik anemi seyrek olarak bildirilmektedir. Bu yazıda, oksaliplatin ilişkili otoimmün hemolitik anemi (OİHA) gelişen bir olgu ve tedavi yaklaşımı tartışılmaktadır. Metastatik kolon kanseri tanısı ile izlenen hasta, oksaliplatin içeren bir kemoterapi protokolünü takiben başlayan kırmızı renkli idrar yapma şikâyeti ile acil servise başvurdu. Hastanın başvurusunda derin anemisi ve retikülositozunun olduğu ve serum biyokimyasının hemoliz ile uyumlu olduğu görüldü. Direk ve indirek Coombs testleri de pozitif olarak bulunan hastaya OİHA tanısı kondu. Oksaliplatinin kesilmesi ve kortikosteroid ve plazmaferez tedavisini takiben hemolizde düzelme izlendi. Oksaliplatin göreceli olarak iyi bir yan etki profiline sahip olmakla birlikte, daha seyrek görülen, ancak şiddetli seyredebilecek immün ilişkili yan etkileri gözden kaçırılmamalıdır. Anahtar Kelimeler: otoimmün hemolitik anemi, oksaliplatin, kolorektal kanser ABSTRACT Oxaliplatin is a third-generation platinum derivative, commonly used in the practice of oncology. The usual side effects include nausea, vomiting, diarrhea, neuropathy and myelosuppression. Oxaliplatin-induced immune thrombocytopenia and immune hemolytic anemia have rarely been reported. Herein, a case of oxaliplatin-induced autoimmune hemolytic anemia(AIHA) and its management have been discussed. The patient with metastatic colorectal carcinoma was admitted to the emergency room with the symptom of reddish coloration of her urine after receiving an oxaliplatin-based regimen. On her admission she had profound anemia with reticulocytosis and a serum biochemistry concordant with hemolysis. The positivity of direct and indirect Coombs tests pointed to the diagnosis of AIHA. Hemolysis improved after discontinuation of oxaliplatin and treatment with corticosteroids and plasmapheresis. Although oxaliplatin has a relatively favorable side effect profile, the possibility of less frequent, but potentially serious immune-related side effects should never be overlooked.

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