Immune‐mediated pancytopenia induced by oxaliplatin: a case report

Abstract

Our case convincingly demonstrates that oxaliplatin led to the production of drug-dependent PLT, RBC, and WBC antibodies inducing pancytopenia in the patient. The oxaliplatin was discontinued and patient's hematologic values recovered to normal levels.

Oxaliplatin-induced Acute Thrombocytopenia: A Case Report and Review of the Literature

“…The frequency of oxaliplatin-induced acute thrombocytopenia is unknown; however, the occurrence rate is probably underestimated because complete blood counts are not routinely performed in patients without severe allergic symptoms or bleeding tendencies. The characteristics of patients diagnosed with oxaliplatin-induced acute thrombocytopenia, including our patient, are summarized in Table. Similar to our case, previous reports (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) have shown that the onset of oxaliplatininduced acute thrombocytopenia is relatively rapid and most affected patients are women (75%) with an average age of 59.8 years (range: 38-83 years). The average number of cycles of onset of thrombocytopenia is 17.3 (range: 9-24 cycles), and all but one case (96%) occurred after 10 cycles of chemotherapy, which suggests that female sex and prolonged exposure to oxaliplatin are risk factors for the development of this reaction.…”

“…Because oxaliplatin-induced acute thrombocytopenia occurs abruptly and is sometimes life-threatening, appropriate therapy should be provided. To the best of our knowledge, 23 cases of oxaliplatin-induced acute thrombocytopenia have been reported (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The frequency of oxaliplatin-induced acute thrombocytopenia is unknown; however, the occurrence rate is probably underestimated because complete blood counts are not routinely performed in patients without severe allergic symptoms or bleeding tendencies.…”

“…Although sufficient evidence of effectiveness has not been provided, corticosteroids were used in almost half the reported cases (52%). This therapy is reasonable because oxaliplatin-induced acute thrombocytopenia, especially that related to immune thrombocytopenia, is related to the development of oxaliplatin-dependent antibodies against the glycoprotein IIb/IIIa complex (8,9,17,18). The exact mechanisms underlying oxaliplatin-induced acute thrombocytopenia are not completely understood; however, current hypotheses suggest that such antibodies naturally occur and can increase the strength of their interaction in the prolonged presence of oxaliplatin, resulting in platelet destruction and thrombocytopenia (2).…”

“…Thrombocytopenia leading to clinical bleeding typically occurs within several hours, although it sometimes occurs up to a few days (9,21). The symptoms sometimes mimic DIC related to severe infection or TTP in the acute phase, and conducting microscopic examinations of peripheral blood smears, coagulation tests and adequate culture studies for possible sepsis is necessary, especially in patients that develop im-mune hemolytic anemia (4,5,7,8,11,12,17,21). Regarding treatment, the platelet counts gradually increase with discontinuation of oxaliplatin; however, the majority of cases (83%) require platelet transfusions during the acute phase.…”

A rare case of acute kidney injury associated with autoimmune hemolytic anemia and thrombocytopenia after long-term usage of oxaliplatin

“…However, the detailed mechanisms underlying the induction of acute hemolysis and thrombocytopenia by oxaliplatin remain unclear. Antibodies against platelets, red blood cells and white blood cells are reportedly positive in patients with pancytopenia induced by oxaliplatin, and positive reactions were observed only in the presence of the drug [14]. As a mechanism for AIHA in this case, drug-induced IgG antibody formation against red blood cells triggered by oxaliplatin was suspected.…”