Oxaliplatin-Induced Acute-Onset Thrombocytopenia, Hemorrhage and Hemolysis

Abstract

Background: Oxaliplatin is a novel platinum derivative with established anti-tumor activity in colorectal cancer. Acute-onset hemolytic anemia and thrombocytopenia associated with this drug have rarely been reported and some of these cases have been severe or even fatal. Case Report: This case report describes a patient who developed fever, chills, abdominal and back pain as well as sudden-onset severe thrombocytopenia, upper gastrointestinal bleeding and hemolysis immediately after treatment with oxaliplatin for metastatic colorectal cancer. The reaction appeared during the 14th cycle of chemotherapy. Corticosteroids and antihistamines were administered together with platelet transfusions. Over the next 2 days platelet count improved and the syndrome abated. The patient was discharged 4 days later. Furthermore, the reaction was accompanied by a strongly positive Coombs test and increased TNF-α and IL-10 serum levels which returned to normal following anti-inflammatory drug administration. Conclusion: Physicians should be aware of the possibility of acute hematological emergencies following oxaliplatin administration.

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.…”

“…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.…”

Oxaliplatin: A Review in the Era of Molecularly Targeted Therapy

“…For instance, hypersensitivity reactions after repeated infusions of oxaliplatin can cause hemolytic anemia and secondary immune thrombocytopenia 22 . In addition, rare cases of secondary acute leukemia have also been reported, as with other alkylating agents 23 .…”

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

“…We investigated 20 cases including that of the present study (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). There were 7 male cases and 13 female cases (Table I).…”