Oxaliplatin-induced acute-onset thrombocytopenia and hemorrhage: Case report and review of the literature

Abstract

Abstract. We report the case of a woman who developed acute thrombocytopenia with hemorrhagic diathesis during adjuvant treatment of colorectal adenocarcinoma with oxaliplatin, 5-fluorouracil and leucovorin. A 55-year-old woman started adjuvant chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin (mFOLFOX6). Prior to starting the 12th course of chemotherapy, a complete blood cell count showed the following values: neutrophils 1800/mm 3 , platelets 136,000/ m 3 and hemoglobin 11.1 g/dl. A blood count revealed that the platelet levels had dropped to 35,000/mm 3 , with no significant changes in hemoglobin levels following the course. The administration of corticosteroids was begun and the platelet number was recovered. Clinicians should be aware of the possibility of oxaliplatin-induced hematological emergencies during the treatment of colorectal cancer patients in order to optimize supportive treatment and avoid toxic mortality.

Oxaliplatin-Related Acute Disseminated Intravascular Coagulation Syndrome in a Patient With Metastatic Colon Cancer

“…Although oncologists are familiar with the predictable hematologic toxicities of oxaliplatin resulting from bone marrow suppression, 5 rare unpredictable hematologic complications have been described, including oxaliplatin-induced immune-mediated hemolytic anemia, thrombocytopenia, and even thrombotic thrombocytopenic purpura. [6][7][8][9][10][11][12] Virtually all cases of oxaliplatininduced immune-mediated hematologic reactions, including this case, share several features in common. The reaction occurs after repeated exposure to the drug (the earliest described event was during the second cycle), with onset of symptoms within minutes to hours after initiation of the oxaliplatin infusion.…”

Case Report: Oxaliplatin-Induced Immune-Mediated Thrombocytopenia

“…Although myelosuppression is the most common cause of thrombocytopenia in cancer patients receiving oxaliplatin, there are several other recognized mechanisms of oxaliplatin-induced thrombocytopenia [1, 2, 3, 4, 5]. With myelosuppression, thrombocytopenia is usually asymptomatic and is accompanied by anemia and neutropenia [6].…”

Oxaliplatin-Induced Immune-Mediated Thrombocytopenia: A Case Report

“…Suzuki et al [ 12 ] reviewed 24 cases of published oxaliplatin-induced acute thrombocytopenia and Ohta et al [ 13 ] reviewed 20 cases. Sixteen of 20 cases in Ohta et al's study [ 13 ] were also included in Suzuki et al's study [ 12 ]. These cases suggested that female gender and prolonged exposure to oxaliplatin were risk factors for developing immune-mediated thrombocytopenia.…”

“…With the exception of symptoms related to thrombocytopenia, patients presented with hypersensitivity reactions such as chills, fever, rash, abdominal or back pain, and bronchospasm. The average number of cycles prior to onset of thrombocytopenia was 16.8 (range, 3 to 25 cycles) in 25 cases in these two studies [ 12 , 13 ]. Most of these oxaliplatin immune-mediated thrombocytopenia cases were induced after 10 cycles of chemotherapy (76% of patients in Suzuki et al [ 12 ] and Ohta et al’s [ 13 ] reports).…”

“…The average number of cycles prior to onset of thrombocytopenia was 16.8 (range, 3 to 25 cycles) in 25 cases in these two studies [ 12 , 13 ]. Most of these oxaliplatin immune-mediated thrombocytopenia cases were induced after 10 cycles of chemotherapy (76% of patients in Suzuki et al [ 12 ] and Ohta et al’s [ 13 ] reports). In the current case, thrombocytopenia occurred in the 40th cycle of oxaliplatin chemotherapy.…”