CARBOPLATIN-INDUCED IMMUNE HEMOLYTIC-ANEMIA

Background: A case of acute hemolysis following therapy with carboplat in, an anticancer chemotherapeutic agent, was investigated, Hemolytic anemia has been associated with cisplatin, a related drug, but not wit h carboplatin. Case Report: An 8-year-old boy was treated for an astro cytoma by monthly intravenous injections of carboplatin. Lower back pa in was noted after 26 monthly injections, and overt intravascular hemo lysis occurred after the 27th injection. The direct antiglobulin test was 4+ with anti-IgG and 1+ with anti-C3d. Results: Blood samples obta ined on Days 28 and 56 after the last injection were tested for carbop latin-dependent antibody. The direct antiglobulin test was 1+ with ant i-IgG; the eluate was 1+ with and without carboplatin, The serum indir ect antiglobulin test was negative in the absence of carboplatin, 3+ t o 4+ in the presence of carboplatin, and 1+ with carboplatin-coated ce lls. Day 56 serum antibody titer was 64 (agglutination at 37 degrees C ), 512 (indirect antiglobulin test) in the presence of carboplatin, an d 8 (indirect antiglobulin test) with carboplatin-coated cells. Conclu sion: The findings indicate a carboplatin-induced antibody reacting in vitro by a complex mechanism combining elements of ''immune complex'' , drug adsorption, and autoantibody mechanisms. Drug-dependent hemolys is is a previously unreported but potentially serious complication of carboplatin therapy.