[Severe hemolysis and SIADH-like symptoms induced by vincristine in an ALL patient with liver cirrhosis].
An 11-year-old boy was diagnosed as having acute lymphoblastic leukemia (ALL, L1) in 1987 and underwent treatment with an ALL high-risk protocol (prednisolone, vincristine (VCR), daunorubicin, 1-asparaginase), which resulted in complete remission. In 1990 he developed chronic hepatitis C and received interferon therapy. In December 1994, ALL recurred, and the patient was treated with VCR. He subsequently developed severe hemolysis (Hb 12.5 g/dl-->6.8 g/dl) with increases of indirect bilirubin, AST, and LDH. Furthermore, symptoms resembling a syndrome of inappropriate secretion of ADH (SIADH) and DIC developed. Upon incubation of the patient's red blood cells with VCR in vitro, extreme deformity of the cells was observed. These findings suggested that splenomegaly, due to liver cirrhosis which had developed rapidly from chronic hepatitis C while the patient was in an immunosuppressed state induced by anticancer drugs, had trapped the deformed red blood cells and resulted in severe hemolysis. The patient died on the 165th day after admission due to liver failure.
Nishihori
Y
Y
Department of Internal Medicine (Section 4), Sapporo Medical University School of Medicine.
Yamauchi
N
N
Kuribayashi
K
K
Sato
Y
Y
Morii
K
K
Hirayama
Y
Y
Sakamaki
S
S
Honma
H
H
Suzuki
N
N
Kudo
T
T
Niitsu
Y
Y
D000293:Adolescent; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D006461:Hemolysis; D006526:Hepatitis C; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000139:chemically induced*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage; D014750:Vincristine / Q000009:adverse effects*
D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine; D011239:Prednisolone; D001215:Asparaginase; D003630:Daunorubicin