Background. Mitomycin C is a powerful antineoplastic agent used in the treatment of intestinal neoplasms. If used at high dosage, it may cause a secondary form of adult hemolytic-uremic syndrome (HUS). If this is the case, it has been suggested that blood transfusions may worsen the evolution of HUS. Heterologous blood may cause intravascular hemolysis causing endothelial damage and worsening of anemia, renal failure and thrombocytopenia. Methods and Results. We describe a clinical case in which a patient developed HUS after treatment with mitomycin C (150 mg/m(2)) for a carcinoma of the ascending colon. Repeated blood transfusions were associated with rapidly evolving renal failure coupled with anemia and thrombocytopenia. Haptoglobin was undetectable. Soon after starting subcutaneous erythropoietin, we observed a stabilization of the renal failure whilst no more blood transfusions were required and haptoglobin levels returned to normal. Two years later, the patient's renal function slowly worsened but the patient is still totally asymptomatic. All investigations failed to show a relapse of her adenocarcinoma. Conclusions. We suggest that erythropoietin may be useful in mitomycin-induced HUS. A possible explanation is that erythropoietin allow interruption of blood transfusions, which may both trigger and perpetuate the syndrome. However, we cannot exclude a primary effect of erythropoietin on the endothelium or on the platelets.
Effect of erythropoietin in mitomycin-induced hemolytic-uremic syndrome
FABBIAN, Fabio;
1999
Abstract
Background. Mitomycin C is a powerful antineoplastic agent used in the treatment of intestinal neoplasms. If used at high dosage, it may cause a secondary form of adult hemolytic-uremic syndrome (HUS). If this is the case, it has been suggested that blood transfusions may worsen the evolution of HUS. Heterologous blood may cause intravascular hemolysis causing endothelial damage and worsening of anemia, renal failure and thrombocytopenia. Methods and Results. We describe a clinical case in which a patient developed HUS after treatment with mitomycin C (150 mg/m(2)) for a carcinoma of the ascending colon. Repeated blood transfusions were associated with rapidly evolving renal failure coupled with anemia and thrombocytopenia. Haptoglobin was undetectable. Soon after starting subcutaneous erythropoietin, we observed a stabilization of the renal failure whilst no more blood transfusions were required and haptoglobin levels returned to normal. Two years later, the patient's renal function slowly worsened but the patient is still totally asymptomatic. All investigations failed to show a relapse of her adenocarcinoma. Conclusions. We suggest that erythropoietin may be useful in mitomycin-induced HUS. A possible explanation is that erythropoietin allow interruption of blood transfusions, which may both trigger and perpetuate the syndrome. However, we cannot exclude a primary effect of erythropoietin on the endothelium or on the platelets.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
