Hemolytic uremic syndrome following the infusion of oxaliplatin: case report

A 52-year-old-male was administered chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin for a Duke's stage C colorectal carcinoma. Three cycles of chemotherapy had been administered without complications when, at the beginning of the fourth cycle, the patient developed clinical and laboratory abnormalities consistent with the development of the hemolytic-uremic syndrome. Treatment was discontinued; the patient was managed with monitored IV hydration and loop diuretics, high dose corticosteroids and fresh frozen plasma infusions and recovered completely.The hemolytic-uremic syndrome may be a rare complication of oxaliplatin-based chemotherapy. Clinicians need to maintain a high index of suspicion to diagnose and treat this life-threatening adverse event.Oxaliplatin (L-OHP) is a third generation platinum derivative with proven effectiveness in the treatment of colorectal cancer. Combined with 5-fluorouracil (5-FU) and leucovorin as a 48 hour infusion every two weeks (FOLFOX regimen), L-OHP is drastic in the adjuvant, first and second line setting [1]. Common adverse effects of this regimen include reversible sensory neuropathy, myelosuppression and nausea [2]. Here, we describe a patient who developed acute hemolysis and thrombocytopenia after the 4th cycle of chemotherapy with FOLFOX.A 52-year-old-male, with a prior history of non-insulin-dependent diabetes mellitus, underwent sigmoidectomy for a moderately differentiated adenocarcinoma of the sigmoid colon. Pathologic staging revealed a Duke's stage C tumor or C1 according to the Astler-Coller classification. A decision was made to administer adjuvant chemotherapy using the FOLFOX-4 regimen (5-FU, 400 mg/m2 bolus infusion on days 1, 2 followed by 5-FU, 600 mg/m2 as a continuous infusion for 22 hours on days 1, 2, leucovorin 200 mg/m2 as a 2 hour infusion prior to 5-FU on days 1, 2 and L-OHP 85 mg/m2 on day 1, every 2 weeks). He was programmed to receive a total of 6 monthly cycles. Treatment was well tolera