Drug-induced immune hemolytic anemia associated with anti-carboplatin and the first example of anti-paclitaxel.
BACKGROUND
Combined chemotherapy with carboplatin and paclitaxel is first-line treatment for lung and ovarian cancer. Drug-induced antibodies to carboplatin are rare but can cause severe, even fatal, hemolysis. Paclitaxel-induced immune hemolysis has not been reported. We describe a case of immune-mediated hemolysis associated with antibodies to carboplatin and paclitaxel in a woman with ovarian cancer who had received multiple chemotherapeutic agents over 7 years, including several courses of these two drugs. She required many transfusions. During a chemotherapy infusion the patient became hypotensive, was pale, and had rigors and red urine. The nadir hematocrit was 12.4%; peak bilirubin and lactate dehydrogenase were 16.3 mg/dL and 1188 units/L, respectively.


METHODS
Blood samples collected within hours after chemotherapy and 2 days later were tested for antibodies to carboplatin and paclitaxel.


RESULTS
The direct antiglobulin test was positive with anti-IgG (3+) and anti-C3 (2+). The plasma collected shortly after chemotherapy agglutinated carboplatin-treated red blood cells (RBCs); untreated and paclitaxel-treated RBCs both reacted at the antiglobulin test most likely due to circulating carboplatin, paclitaxel, or both drugs. Serum collected 2 days later agglutinated (titer 2) and sensitized (titer 128) carboplatin-treated RBCs; untreated and paclitaxel-treated RBCs were nonreactive. An acid eluate reacted weakly in the presence of polyethylene glycol with carboplatin-treated RBCs. The serum reacted with untreated and enzyme-treated RBCs in the presence of soluble carboplatin and paclitaxel.


CONCLUSIONS
Anti-carboplatin and the first example of anti-paclitaxel were detected in this patient's sample.
American Red Cross Blood Services, Southern California Region, Pomona, California.
Regina M
RM
Leger
Bloodworks Northwest and the 2Departments of Hematology and Laboratory Medicine, University of Washington Medical Center, Seattle, Washington.
Shweta
S
Jain
Bloodworks Northwest and the 2Departments of Hematology and Laboratory Medicine, University of Washington Medical Center, Seattle, Washington.
Theresa A
TA
Nester
Swedish Medical Center, Seattle, Washington.
Henry
H
Kaplan
D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced*; D000970:Antineoplastic Agents / Q000276:immunology*; D016190:Carboplatin / Q000276:immunology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000276:immunology*
D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel