Dados do Trabalho

Título

OXALIPLATIN-INDUCED-IMMUNE OR IDIOPATHIC THROMBOCYTOPENIC PURPURA: CASE REPORT

Apresentação do caso

Patient M.I.S.S., female, 52 years old, hypertensive using atenolol 25mg/day and social drinker, diagnosed with colon adenocarcinoma (rectosigmoid), performed left hemicolectomy and lymphadenectomy on November 2017, pathological stage IIIC, followed by adjuvant chemotherapy on the FOLFOX scheme (5-FU, leucovorin and oxaliplatin) for 6 months. She began follow-up until February 2020, when she presented a single pulmonary recurrence, opting for pulmonary metastasectomy and reintroduction of chemotherapy (FOLFOX). After 3 months of chemotherapy, the patient developed acute thrombocytopenia (10,000/mm3 platelets), 12 hours after the infusion of the platinum agent, she developed purpura on the tongue, soft and hard palate. It was performed bone marrow aspirate with the result of post-chemotherapy dysplasia and decreased thrombocytopenia, suggested the possibility of immune thrombocytopenic purpura (ITP) and started treatment with steroid, prednisone 1 mg/kg/day for 21 days, followed by progressive weaning. After 48 hours from the start of corticosteroid therapy, the purpuras resolved completely and platelets rose to 175,000/mm3, oxaliplatin was definitively suspended and chemotherapy was subsequently started with fluoropyrimidine and irinotecan.

Discussão

Oxaliplatin-induced thrombocytopenia affects up to 70% of patients, only 3-4% have grade 3-4, the most common cause is myelosuppression, another mechanism is splenic sequestration and consequently portal hypertension due to injury to the hepatic sinusoids caused by oxaliplatin, characterized by thrombocytopenia and prolonged splenomegaly. Ultimately, secondary immune-mediated thrombocytopenia, induced by drugs, that form specific antibodies to the oxaliplatin-dependent platelet glycoprotein IIb / IIIa complex, which bind to macrophages, inducing a rapidly evolving thrombocytopenia (within 1-2 days), the diagnosis is given by exclusion or detection of the antibody, and the treatment is based on the suspension of the cause
The patient didn’t present pancytopenia or bicytopenia, she developed sudden isolated thrombocytopenia (hours) not associated with splenomegaly or portal hypertension. In addition, the rapid recovery after the start of corticosteroid therapy which justifies the diagnosis of exclusion of ITP.

Comentários finais

Oxaliplatin-induced ITP is a rare complication that requires definitive discontinuation of the drug.

Palavras-chave

Idiopathic or immune thrombocytopenic purpura, oxaliplatin and thrombocytopenia