An immediate hemolytic reaction induced by repeated administration of oxaliplatin.
BACKGROUND
Platinum-based chemotherapy agents have been associated with potentially fatal acute immune-mediated hemolytic anemia. The target antigen, cause of the positive direct antiglobulin test (DAT) and mechanism of hemolysis have been the subject of controversy.


METHODS
We report a patient who developed a DAT-positive hemolytic episode after a red cell (RBC) transfusion was delivered during the infusion of her 17th cycle of oxaliplatin. Standard pretransfusion testing was uncomplicated; however, after infusion, the serum was no longer compatible with the transfused units and a strong (4+) panreactive IgG antibody was detected.


RESULTS
The patient's serum from 10 days after the episode, only when therapeutic concentrations of oxaliplatin were added, reacted with all RBCs tested using the indirect antiglobulin test (IAT) (3+). The effect was retained with a purified IgG fraction and almost eliminated with IgG-depleted serum. Immunoprecipitation analysis revealed a band with the molecular weight of the Band 3 anion channel only in the presence of the patient's serum and oxaliplatin.


CONCLUSIONS
Our investigations indicated that oxaliplatin interacted with both an IgG antibody and a RBC membrane epitope probably located on the Band 3 anion channel.
Chen
Vivien M Y
VM
Department of Hematology and Transfusion Medicine, Northern Blood Research Center and Pacific Laboratory Medicine Services, Royal North Shore Hospital, Sydney, NSW, Australia.
Thrift
Karen M
KM
Morel-Kopp
Marie-Christine
MC
Jackson
David
D
Ward
Christopher M
CM
Flower
Robert L
RL
D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced*; D000918:Antibody Specificity; D000941:Antigens / Q000187:drug effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001788:Blood Grouping and Crossmatching; D001803:Blood Transfusion; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003907:Dexamethasone / Q000008:administration & dosage; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077150:Oxaliplatin
D000941:Antigens; D000970:Antineoplastic Agents; D007074:Immunoglobulin G; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D000077146:Irinotecan; D003907:Dexamethasone; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin