Life-threatening oxaliplatin-induced acute thrombocytopenia, hemolysis and bleeding: A case report

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.…”

“…In the present case, the patient experienced a severe hypersensitivity reaction characterized by chills, fever and hypertension simultaneously with acute thrombocytopenia. Several previous cases have reported similar allergic symptoms related to thrombocytopenia (6,7,11,12,18). However, it is unknown whether hypersensitivity reactions, possibly resulting from a massive release of inflammatory cytokines, can induce destruction of platelets.…”

“…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.…”

“…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.…”

“…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. The average platelet count at onset is 17,000 / μL, and various symptoms such as chills (6, 7, 12, 18), fever (7), skin rashes (6, 18), abdominal or back pain (5,9,11,12), nausea (13,21), dizziness (21), mental status changes (13) and bronchospasm (18) are experienced, with the exception of bleeding tendencies. Because oxaliplatin-induced acute thrombocytopenia does not always accompany a bleeding tendency at the time of initial presentation, physicians need to pay careful attention and initiate blood testing for thrombocytopenia to manage patients with unexplained symptoms who receive oxaliplatin.…”