Carboplatin
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Carboplatin Hypersensitivity reaction manifesting as fever, generalised malaise, dyspnoea and palmar pruritus, and immune haemolytic anaemia: case report
A 37-year-old woman developed a hypersensitivity reaction in the form of fever, generalised malaise, dyspnoea and palmar pruritus, and immune haemolytic anaemia during treatment with carboplatin for ovarian papillary carcinoma. The woman, who had been diagnosed with ovarian papillary carcinoma at the age of 14 years (currently stage IV), had subsequently received multiple lines of chemotherapy, which included two lines of carboplatin in 2000 and 2008. Later, in 2009, during the first cycle of carboplatin infusion as third-line therapy [dosage not stated], she developed fever, generalised malaise, severe dyspnoea and palmar pruritus, which were attributed to a hypersensitivity reaction to carboplatin. The carboplatin infusion was discontinued; the woman received unspecified symptomatic treatment and recovered immediately. Thereafter, she tolerated another 5 cycles of carboplatin with premedication comprising methylprednisolone [6-methylprednisolone] and dexchlorpheniramine. Later, in 2016, she required carboplatin again; hence, she was referred to an allergy department for evaluation. Intradermal and prick tests to carboplatin 1 mg/mL were found to be negative. She tolerated the first cycle of carboplatin 395mg [route not stated] after a desensitisation protocol, which involved premedication with aspirin, cetirizine, montelukast and prednisolone. The subsequent cycles were administered monthly with the same regimen. After receiving cycle 10, she became presyncopal with fading vision. During this time, her BP remained unchanged from baseline, and she received serum therapy without improvement. She reported lumbar back pain and dysthermia. Therefore, she was shifted to the emergency department. Of note, she experienced no signs of an immediate hypersensitivity reaction, including pruritus, dyspnoea and angioedema. At the emergency department, she was found to have an increased axillary temperature of 37.8°C; however, her oxygen saturation was stable. Laboratory analyses revealed the following: Hb 6.3 g/dL, LDH 2052 IU/L and total bilirubin 3.9 mg/dL. Blood tests from the previous 48 hours revealed a normal Hb of 11.2 g/dL, LDH of 200 IU/L and a total bilirubin of 0.5 mg/dL. She underwent three RBC transfusions. She also received methylprednisolone and levofloxacin. Forty-eight hours post carboplatin administration, she developed an acute bilateral pulmonary thromboembolism. She was admitted to the ICU, where she underwent fibrinolysis. She also received cyclophosphamide, immune globulin, rituximab and multiple transfusions of RBCs, after which her Hb peaked at 9 g/dL. Over the subsequent days, her Hb again dropped to 6.5 g/dL, suggesting persistent haemolysis. Therefore, her serum was analysed: ABO group was O, with positive Rh type. Liss indirect antiglobulin test (IAT) was also found to be positive. Polyethylene glycol antibody identification test revealed an
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