Serologic characteristics of oxaliplatin antibodies in 15 patients with drug‐induced immune hemolytic anemia. Issue 5 (13th March 2021)

• Record Type: Journal Article
• Authors: Nguyen, Tan Ngoc; Maenulein, Elodie; Fihman, Valentine; Vinatier, Isabelle; Moh Klaren, Julia
• Is Part Of: Transfusion. Volume 61:Issue 5(2021)
• Page Start: 1609
• Page End: 1616
• Publication Date: 2021-03-13
• Subjects: anti‐oxaliplatin -- colorectal cancer -- drug‐induced immune hemolytic anemia; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.16360
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract: Background: Oxaliplatin, a third‐generation platinum derivative is commonly used in combination treatment of metastatic colorectal cancer. Since 2008, it is the second most common cause of drug‐induced immune hemolytic anemia (DIIHA) investigated in our laboratory. Study Design and Methods: Samples from fifteen patients including nine (60%) with intravascular hemolysis, suspected of having DIIHA were studied for the presence of anti‐oxaliplatin. Direct antiglobulin tests (DATs) and tests with oxaliplatin‐treated red blood cells (RBCs) or untreated and enzyme‐treated RBCs in the presence of oxaliplatin were performed. A pool of normal AB sera with no unexpected antibodies was used as a control for nonimmunologic protein adsorption (NIPA). Results: Eleven (73%) of the fifteen patients had antibodies to oxaliplatin that reacted with drug‐treated RBCs and untreated RBCs in the presence of drug by tube and/or gel method. Lower‐titer reactivity (<20) obtained with four patients' sera and the corresponding pooled normal sera was most likely due to NIPA. Eighty seven percent (13/15) of the patients had positive DAT either with anti‐IgG only (33%), IgG + C3d (40%), or C3d only (13%). Two patients had a negative DAT. No directly agglutinating antibody was observed with the pools of normal donor's sera in the presence of oxaliplatin. Conclusion: Anti‐oxaliplatin can cause severe intravascular hemolysis. Complement can usually be detected on the patient's RBCs and anti‐oxaliplatin can be detected in the patient's serum. RBC‐bound albumin detection with anti‐human albumin needs to be performed to confirm NIPA which could have contributed to the patient's hemolytic anemia.