SUCCESSFUL TREATMENT OF CISPLATIN-INDUCED HEMOLYTIC-UREMIC SYNDROME WITH THERAPEUTIC PLASMA-EXCHANGE

Cisplatin is a known cause of hemolytic uremic syndrome (HUS), The acu te, fulminant form of cisplatin-induced HUS Is almost always fatal, We present a 67-year-ord Hispanic woman who was treated with cisplatin f or squamous cell carcinoma of the tongue. Three days after receiving t he treatment, she presented with increasing fatigue, decreased urine o utput, and confusion. Physical examination was remarkable for tachycar dia of 130 beats/min, peripheral edema, and mental obtundation. Labora tory investigations showed a white cell count of 5,500/mu L hemoglobin level of 9.6 g/dL, hematocrit of 29.6%, and platelet count of 13,000/ mu L. Schistocytes were present on peripheral smear. Screening for dis seminated intravascular coagulation was negative. Serum chemistry valu es included blood urea nitrogen 111 mg/dL, creatinine 3.8 mg/dL, and l actate dehydrogenase (LDH) 927 IU, The patient underwent hemodialysis and therapeutic plasma exchange (TPE), using fresh frozen plasma (FFP) , Dialysis was no longer required after the fifth day. TPE was perform ed daily until the platelet count normalized on the 13th day, after wh ich intertreatment intervals were extended until normalization of LDH levels on the 50th day. We conclude that the normally fatal, fulminant form of cisplatin-induced HUS can be successfully treated with standa rd TPE, using FFP replacement. (C) 1998 by the National Kidney Foundat ion, Inc.