内容紹介
Three Cases of Fatal Thrombocytopenia after Oxaliplatin-Based Chemotherapy
Summary
Oxaliplatin is a platinum salt that is particularly effective for treating gastrointestinal tumors. However, some reports state that oxaliplatin-based chemotherapy triggers fatal thrombocytopenia. Myelosuppression is recognized as the main cause of oxaliplatin-related thrombocytopenia, and other mechanisms for this side effect have been suggested, including splenic sequestration of platelets related to oxaliplatin-induced liver damage and immune thrombocytopenia. Other causes of thrombocytopenia such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, heparin-induced thrombocytopenia, and pseudothrombocytopenia should also be considered. We encountered 3 patients who developed fatal thrombocytopenia after oxaliplatin-based chemotherapy and describe the differential diagnosis of fatal thrombocytopenia here.
要旨
oxaliplatin(L-OHP)は切除不能進行大腸癌,大腸癌術後補助化学療法のkey drugの一つである。まれな副作用として,著明な血小板減少を来すことが報告されている。L-OHPに起因する血小板減少の機序としては,① 肝類洞障害によるもの,② 免疫反応によるもの,③ 骨髄抑制によるものと分類されている。その他にもTTP,ITP,HIT,偽性血小板減少症など,化学療法に直接関与していないが血小板減少を来す病態も考慮しなければいけない。当院で経験したL-OHPを含む化学療法中に著明な血小板減少を来した3症例をとおして,血小板減少を来す原因を検証し,文献的考察を含め報告する。
目次
Summary
Oxaliplatin is a platinum salt that is particularly effective for treating gastrointestinal tumors. However, some reports state that oxaliplatin-based chemotherapy triggers fatal thrombocytopenia. Myelosuppression is recognized as the main cause of oxaliplatin-related thrombocytopenia, and other mechanisms for this side effect have been suggested, including splenic sequestration of platelets related to oxaliplatin-induced liver damage and immune thrombocytopenia. Other causes of thrombocytopenia such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, heparin-induced thrombocytopenia, and pseudothrombocytopenia should also be considered. We encountered 3 patients who developed fatal thrombocytopenia after oxaliplatin-based chemotherapy and describe the differential diagnosis of fatal thrombocytopenia here.
要旨
oxaliplatin(L-OHP)は切除不能進行大腸癌,大腸癌術後補助化学療法のkey drugの一つである。まれな副作用として,著明な血小板減少を来すことが報告されている。L-OHPに起因する血小板減少の機序としては,① 肝類洞障害によるもの,② 免疫反応によるもの,③ 骨髄抑制によるものと分類されている。その他にもTTP,ITP,HIT,偽性血小板減少症など,化学療法に直接関与していないが血小板減少を来す病態も考慮しなければいけない。当院で経験したL-OHPを含む化学療法中に著明な血小板減少を来した3症例をとおして,血小板減少を来す原因を検証し,文献的考察を含め報告する。