Immune hemolytic anemia with drug‐induced antibodies to carboplatin and vincristine in a pediatric patient with an optic pathway glioma

Abstract

The patient developed hemolytic anemia during chemotherapy. Initial detection of a panagglutinin suggested a warm-type autoimmune process. However, since DIIHA could not be excluded, chemotherapy was discontinued and further work-up was initiated. The findings confirmed the presence of antibodies to carboplatin and VCR. This case highlights the importance for clinicians to maintain a high index of suspicion for DIIHA in patients with unexplained hemolysis and the importance of specialized serologic testing.

Unusual serological findings associated with ceftriaxone‐induced immune hemolytic anemia in a child with disseminated low‐grade glioma

“…Neurooncology patients exposed to ceftriaxone may develop CIHA. Our patient suffered a classic, life‐threatening drop in hemoglobin, and rapidly improved after blood transfusion and discontinuation of ceftriaxone. High suspicion for CIHA and timely serologic evaluation confirmed the diagnosis.…”

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.…”

“…Of interest, this is the second case, to our knowledge, where antibodies to two chemotherapeutics were detected at the time of the hemolytic event. In the report by Betensky and colleagues, the patient made an antibody to vincristine in addition to the carboplatin. It should not come as a surprise that a patient could make antibodies to more than one drug when both are being administered repeatedly.…”

“…She died within 7 hours despite aggressive treatment. In the case described by Betensky and colleagues, a 35‐month‐old girl with an optic nerve glioma was shown to have antibodies to both carboplatin and vincristine after a 2‐g decrease in her Hb from the previous week was noted. In the weeks before this episode, the child complained of back and abdominal pain after vincristine infusions and her mother recalled tea‐colored urine at home.…”

“…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.…”