title: Immune-mediated pancytopenia induced by oxaliplatin: a case report.
abstract: BACKGROUND
  Drug-induced immune pancytopenia is considered an uncommon disorder.
  
  
  METHODS
  A 76-year-old woman with metastatic gastric adenocarcinoma received 15 cycles of FOLFOX-6 (oxaliplatin/folinic acid/fluorouracil) with a complete response. Upon disease progression, she was restarted on FOLFOX; during the seventh cycle of treatment, 1 hour after completing her oxaliplatin infusion, she presented oral bleeding, petechiae and generalized hematomas. Her platelet (PLT) count decreased from 164 x 10(9)/L to less than 5 x 10(9)/L within a 3-hour period and her white blood cells (WBCs) decreased from 5 x 10(9) to 1.5 x 10(9)/L. One day later she presented a decrease in hemoglobin level (from 11.4 to 10 g/dL, reaching 8.9 g/dL after 5 days). The patient's PLT and lymphocyte count started to recover after 3 days of immunosuppressive treatment.
  
  
  METHODS
  PLT, red blood cell (RBC), and WBC antibody detection tests were performed in the presence and absence of oxaliplatin. PLT-associated antibodies were evaluated by monoclonal antibody immobilization of PLT antigen assay and flow cytometry; WBC antibodies were tested by flow cytometry; and RBC antibodies were evaluated by gel and indirect antiglobulin test tube testing drug-treated RBCs and untreated RBCs in the presence of drug.
  
  
  RESULTS
  Positive reactions were obtained only in the presence of the drug (1 mg/mL) for all tests performed (PLTs, RBCs, and WBCs).
  
  
  CONCLUSIONS
  Our case convincingly demonstrates that oxaliplatin led to the production of drug-dependent PLT, RBC, and WBC antibodies inducing pancytopenia in the patient. The oxaliplatin was discontinued and patient's hematologic values recovered to normal levels.
authors.affiliation: Blood Bank and Oncology Center, Hospital Sírio Libanês, São Paulo, SP, Brazil. rita.f.wendel@terra.com.br
authors.forename: Rita
authors.initials: R
authors.lastname: Fontão-Wendel
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.forename: Arlette
authors.initials: A
authors.lastname: Lazar
authors.forename: Daniela
authors.initials: D
authors.lastname: Freitas
authors.forename: Yana
authors.initials: Y
authors.lastname: Novis
authors.forename: Poliana
authors.initials: P
authors.lastname: Patah
authors.forename: Maristela
authors.initials: M
authors.lastname: Tsujita
authors.forename: Adriana
authors.initials: A
authors.lastname: Balthazar
authors.forename: Márcia
authors.initials: M
authors.lastname: Pierroti
authors.forename: Silvano
authors.initials: S
authors.lastname: Wendel
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001792:Blood Platelets / Q000276:immunology; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000276:immunology; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010198:Pancytopenia / Q000139:chemically induced*; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin