Fatal carboplatin-induced immune hemolytic anemia in a child with a brain tumor

Abstract

Kristina M Haley,1 Thomas B Russell,2 Lynn Boshkov,3 Regina M Leger,4 George Garratty,4,† Michael Recht,1 Kellie J Nazemi11Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, 2Division of Pediatric Hematology/Oncology, Department of Pediatrics, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 3Departments of Pathology, Medicine and Pediatrics, Oregon Health and Science University, Portland, OR, 4American Red Cross Blood Services, Pomona, CA, USA †George Garratty passed away March 2014Abstract: Drug-induced immune hemolytic anemia (DIIHA) is an uncommon side effect of pharmacologic intervention. A rare mediator of DIIHA, carboplatin is an agent used to treat many pediatric cancers. We describe here, the first case of fatal carboplatin induced DIIHA in a pediatric patient and a brief review of the literature. Our patient developed acute onset of multi-organ failure with evidence of complement activation, secondary to a drug induced red cell antibody. Early recognition of the systemic insult associated with carboplatin induced hemolytic anemia may allow for future affected patients to receive plasmapheresis, a potentially effective therapy.Keywords: hemolytic anemia, carboplatin, glioma, complement fixation, drug-induced hemolysis