Epirubicin
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Thrombocytopenic bleeding, neutropenic fever and upper GI bleeding: case report In a study of 58 patients with a diagnosis of acute myeloid leukaemia over a 7 year period at the University College Hospital, Ibadan, Nigeria, a 15-year-old boy was described; who developed thrombocytopenic bleeding, neutropenic fever and upper GI bleeding during treatment with epirubicin for acute myeloid leukaemia [AML; dosage, route, duration of treatment to reaction onsets and outcomes not stated]. The boy with the co-inheritance of haemoglobin S (HbS) with another abnormal haemoglobin C, sickle cell disease (SCD) had been diagnosed with AML-M4. He presented with recurrent fever and recurrent anaemia. His medical history indicated that he had not been regular with hospital follow-up and unspecified routine medications. At presentation, the investigations were consistent with AML-M4. He then received cytarabine [cytosine arabinoside] for 1 week because of unavailability of blood products. On day 16 of admission, he was started on 1st cycle, second course of re-induction of remission with doxorubicin and cytarabine. His cardiac ECHO revealed aortic annulus sclerosis with mild pericardial effusion and mild pulmonary regurgitation. Therefore, doxorubicin was replaced with epirubicin in the 2nd cycle of the 2nd course of re-induction of remission. However, his 2nd cycle with epirubicin was complicated by severe neutropenic fever, upper GI bleeding and thrombocytopenic bleeding. The boy was admitted for about two and a half months under supervision of ophthalmologist, cardiologist, gastroenterologist and medical microbiologist. He was transfused with 9 units of fresh whole blood and 12 units of random donor platelet concentrate. He received granulocyte colony stimulating factor (GCSF) during the second cycle of chemotherapy. The consolidation chemotherapy could not be instituted as his father denied further chemotherapy and thus he was discharged in second remission with a bone marrow blast of less than 5%. Four weeks after discharge, he re-presented with difficulty with breathing, fever and died before any medical intervention could be provided [exactcause of death not stated]. Aworanti OW, et al. Acute leukemia in sickle cell disease patients in a tertiary health facility in Nigeria: A case series. African Health Sciences 20: 1304-1312, No. 3, Sep 803517410 2020. Available from: URL: http://doi.org/10.4314/ahs.v20i3.36
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Reactions 28 Nov 2020 No. 1832
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