Carboplatin Induced Fatal Autoimmune Hemolytic Anemia: First Reported Case

Abstract

Carboplatin is an alkylating anti-neoplastic drug used in various cancers especially ovarian cancer, germ cell tumors, endometrial cancer besides others. We present a case of acute autoimmune hemolytic anemia during Carboplatin infusion in a patient previously exposed to the drug, resulting in the death of the patient. Published reports of Carboplatin induced autoimmune hemolytic anemia suggest these are usually nonfatal and improve after discontinuation of the drug. Fatal autoimmune hemolysis from Carboplatin has not been reported to the best of our knowledge. A 77-year-old Caucasian lady with history of endometrial adenocarcinoma was receiving treatment with a combination of Carboplatin and Paclitaxel for recurrent adenocarcinoma presenting as a pelvic mass. She tolerated similar chemotherapy previously, except for mild side effects. During her fifth cycle of chemotherapy with Carboplatin, she suddenly collapsed in the infusion center. Despite aggressive treatment, she expired within seven hours. A direct Coomb’s test was found to be positive. Carboplatin dependent antibody was also detected. She was felt to have had a Carboplatin-induced fatal hemolytic anemia. Acute autoimmune hemolytic anemia with Carboplatin is rare but could be a devastating complication. A sudden drop in hemoglobin during Carboplatin infusion should alert clinicians of this extremely fatal possibility.

Postoperative Recurrence of Invasive Thymoma with Cold Agglutinin Disease and Autoimmune Hemolytic Anemia

“…According to 126 reports between 1978 and 2004, cefotetan (62%), ceftriaxone (10%), β-lactamase inhibitors (8%), and others (14%) were reported (5). Regarding treatments related to anticancer drugs, cisplatin and carboplatin were reported (6,7). In the present case, cisplatin was only used as a first-line treatment.…”

Drug‐induced immune hemolytic anemia associated with anti‐carboplatin and the first example of anti‐paclitaxel

“…The platinum chemotherapeutics include cisplatin, oxaliplatin, and carboplatin. All three have been associated with DIIHA, although serologic testing for antibodies was not performed for all cases in the literature . Typically, investigation of DIIHA is pursued when a patient who is hemolyzing has a positive DAT, but a nonreactive eluate and no new serum antibody reactivity.…”

“…Five cases of DIIHA associated with antibodies to carboplatin have been reported, of which two were fatal . Maloisel and colleagues described hemolysis due to carboplatin in a 44‐year‐old woman; however, her DAT was negative and her hemolysis did not worsen with additional doses of carboplatin.…”

“…The authors noted that hemolysis might explain transient anemia and back pain after the two previous injections. Dacha and coworkers described the first fatality attributed to carboplatin‐induced immune hemolytic anemia in a 77‐year‐old woman with endometrial adenocarcinoma. Just before her fifth cycle of carboplatin plus paclitaxel therapy, the patient's Hb was 10.4 g/dL.…”

“…5 Five cases of DIIHA associated with antibodies to carboplatin have been reported, of which two were fatal. [6][7][8][9][10] Maloisel and colleagues 6 described hemolysis due to carboplatin in a 44-year-old woman; however, her DAT was negative and her hemolysis did not worsen with additional doses of carboplatin. Marani and coworkers 7 described an 8-year-old boy with astrocytoma who had acute hemolysis after the 26th monthly injection of carboplatin.…”