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Acute immune-mediated thrombocytopenia: case report A 63-year-old woman developed acute immune-mediated thrombocytopenia during treatment with oxaliplatin and irinotecan for metastatic colon cancer [routes and doses not stated]. The woman, who had colon cancer with liver metastases and ascites, started receiving cyclical palliative chemotherapy with infusion of FOLFOX regimen comprising fluorouracil [5-fluorouracil], folinic acid [leucovorin] and oxaliplatin along with cetuximab. The initial blood work before initiation of chemotherapy showed the following: platelet count 102 000 /µL, haemoglobin 9.7 g/dL and total WBC count 9000 /µL. She tolerated the treatment well with stable disease. She completed 14 cycles of FOLFOX regimen with minimal effects on the platelet count. Two days after the completion FOLFOX therapy, she developed melaena. Laboratory tests showed decreased platelet count and haemoglobin level with elevated WBC count. She was diagnosed with severe acute thrombocytopenia. The woman was hospitalised and transfused with three units of platelets and two units of packed RBCs with minimal improvement in her laboratory findings. After 5 days of hospitalisation, her platelet count improved further and she was subsequently discharged. One month later, she started receiving the second-line chemotherapy with infusion of FOLFIRI regimen comprising irinotecan, fluorouracil and folinic acid along with cetuximab. After completion of the first cycle of irinotecan, she developed rectal bleeding. She was admitted again. Further blood work-up showed a severe decrease in platelet count (thrombocytopenia) within 24h following the completion of FOLFIRI infusion. A FOLFIRIinduced thrombocytopenia was initially considered, and a peripheral blood sample was tested for the presence of platelet drug-dependent antibodies (DDAbs). A flow cytometry showed a positive result for the presence of DDAbs to oxaliplatin and irinotecan, while the test was negative for fluorouracil and cetuximab DDAbs. Based on these findings, a final diagnosis of acute immune-mediated thrombocytopenia secondary to oxaliplatin and irinotecan was made. Thereafter, she was transfused with platelets and treated with dexamethasone. Eventually, an improvement in her condition was noted and platelet count normalised to baseline over the next few weeks. Later, her treatment was temporary discontinued. Worsening of her clinical condition was noted. She opted for the best supportive care. Later, she died in hospice [cause of death not stated]. Author comment: "In this report, we describe a patient who developed acute immune-mediated thrombocytopenia to both oxaliplatin and irinotecan with the presence of bleeding symptoms during the treatment of metastatic colon cancer." Tam EL, et al. Acute Immune-Mediated Thrombocytopenia due to Oxaliplatin and Irinotecan Therapy. Case Reports in Oncological Medicine 2019: Jan 2019. 803440820 Available from: URL: http://doi.org/10.1155/2019/4314797 - USA

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