Drug-induced immune hemolytic anemia associated with anti-carboplatin and the first example of anti-paclitaxel

BACKGROUND Combined chemotherapy with carboplatin and paclitaxel is first‐line treatment for lung and ovarian cancer. Drug‐induced antibodies to carboplatin are rare but can cause severe, even fatal, hemolysis. Paclitaxel‐induced immune hemolysis has not been reported. We describe a case of immune‐mediated hemolysis associated with antibodies to carboplatin and paclitaxel in a woman with ovarian cancer who had received multiple chemotherapeutic agents over 7 years, including several courses of these two drugs. She required many transfusions. During a chemotherapy infusion the patient became hypotensive, was pale, and had rigors and red urine. The nadir hematocrit was 12.4%; peak bilirubin and lactate dehydrogenase were 16.3 mg/dL and 1188 units/L, respectively. STUDY DESIGN AND METHODS Blood samples collected within hours after chemotherapy and 2 days later were tested for antibodies to carboplatin and paclitaxel. RESULTS The direct antiglobulin test was positive with anti‐IgG (3+) and anti‐C3 (2+). The plasma collected shortly after chemotherapy agglutinated carboplatin‐treated red blood cells (RBCs); untreated and paclitaxel‐treated RBCs both reacted at the antiglobulin test most likely due to circulating carboplatin, paclitaxel, or both drugs. Serum collected 2 days later agglutinated (titer 2) and sensitized (titer 128) carboplatin‐treated RBCs; untreated and paclitaxel‐treated RBCs were nonreactive. An acid eluate reacted weakly in the presence of polyethylene glycol with carboplatin‐treated RBCs. The serum reacted with untreated and enzyme‐treated RBCs in the presence of soluble carboplatin and paclitaxel. CONCLUSION Anti‐carboplatin and the first example of anti‐paclitaxel were detected in this patient's sample.