title: Three cases of hemolytic uremic syndrome in ovarian cancer patients treated with combination gemcitabine and pegylated liposomal doxorubicin.
abstract: BACKGROUND
  Hemolytic uremic syndrome (HUS) is a rare coagulation disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute uremia. Reports have described this fatal syndrome in association with cytotoxic agents. To our knowledge, no case reports of HUS in ovarian cancer patients receiving treatment with combination gemcitabine and pegylated liposomal doxorubicin (PLD) have been reported.
  
  
  METHODS
  Three patients with recurrent ovarian carcinoma each developed profound hypertension and peripheral edema while receiving combination gemcitabine and PLD. The first patient had rapid hemolysis, thrombocytopenia, renal failure and respiratory distress. The other patients experienced slowly progressive renal failure and mild hematologic abnormalities. Two of the three patients had favorable outcomes.
  
  
  CONCLUSIONS
  The reported incidence of gemcitabine-induced HUS is rare. Clinicians should suspect HUS if blood pressure elevation or peripheral edema develop.
authors.affiliation: Division of Gynecologic Oncology, Washington University School of Medicine, 4911 Barnes Jewish Hospital Plaza, Box 8064, St. Louis, MO 63110-1094, USA. lewins@msnotes.wustl.edu
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Bradford P
authors.initials: BP
authors.lastname: Whitcomb
authors.forename: Helen
authors.initials: H
authors.lastname: Liapis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D004317:Doxorubicin; D000093542:Gemcitabine