title: Transiently Pink-Tinged Serum in a Patient With Multiple Myeloma and Anemia Undergoing Lenalidomide Treatment.
abstract: OBJECTIVE
  While in vitro hemolysis is a preanalytical interferent, in vivo hemolysis is a pathologic process requiring investigation. We present a case of an anemic patient with multiple myeloma undergoing chemotherapy with lenalidomide who had multiple serum samples drawn before and after chemotherapy treatment. Some of these samples showed hemolysis. This triggered further investigations to differentiate the cause of the hemolysis.
  
  
  METHODS
  Various laboratory tests and additional investigations were necessary to establish the root of the hemolytic process.
  
  
  RESULTS
  Multiple laboratory tests and a rigorous review of the samples, time of collection, and laboratory results revealed that only samples collected shortly after lenalidomide administration showed hemolysis. This indicates that the chemotherapeutic agent itself was most likely the proximate cause of the in vivo hemolysis in a non-immune-mediated manner.
  
  
  CONCLUSIONS
  Upon administration, chemotherapeutic agents, such as lenalidomide, can immediately induce transient hemolysis, which can be visualized as transiently pink-tinged serum samples.
authors.affiliation: From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.
authors.forename: Whitney
authors.initials: W
authors.lastname: Wedel
authors.affiliation: From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha. alina.sofronescu@unmc.edu.
authors.forename: Alina G
authors.initials: AG
authors.lastname: Sofronescu
mesh_terms: D000740:Anemia / Q000150:complications; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006461:Hemolysis; D006801:Humans; D000077269:Lenalidomide; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D000077269:Lenalidomide
keywords: Anemia; Chemotherapy; In vivo hemolysis; Lenalidomide; Macrocytosis; Multiple myeloma