Palmisano J, Agraharkar M, Kaplan A A
Division of Nephrology, University of Connecticut Health Center, Farmington 06030, USA.
Am J Kidney Dis. 1998 Aug;32(2):314-7. doi: 10.1053/ajkd.1998.v32.pm9708619.
Cisplatin is a known cause of hemolytic uremic syndrome (HUS). The acute, fulminant form of cisplatin-induced HUS is almost always fatal. We present a 67-year-old Hispanic woman who was treated with cisplatin for squamous cell carcinoma of the tongue. Three days after receiving the treatment, she presented with increasing fatigue, decreased urine output, and confusion. Physical examination was remarkable for tachycardia of 130 beats/min, peripheral edema, and mental obtundation. Laboratory investigations showed a white cell count of 5,500/microL, hemoglobin level of 9.6 g/dL, hematocrit of 29.6%, and platelet count of 13,000/microL. Schistocytes were present on peripheral smear. Screening for disseminated intravascular coagulation was negative. Serum chemistry values included blood urea nitrogen 111 mg/dL, creatinine 3.8 mg/dL, and lactate dehydrogenase (LDH) 927 IU. The patient underwent hemodialysis and therapeutic plasma exchange (TPE), using fresh frozen plasma (FFP). Dialysis was no longer required after the fifth day. TPE was performed daily until the platelet count normalized on the 13th day, after which intertreatment intervals were extended until normalization of LDH levels on the 50th day. We conclude that the normally fatal, fulminant form of cisplatin-induced HUS can be successfully treated with standard TPE, using FFP replacement.
顺铂是溶血性尿毒症综合征（HUS）的已知病因。顺铂诱导的急性暴发性HUS几乎总是致命的。我们报告一名67岁的西班牙裔女性，她因舌鳞状细胞癌接受顺铂治疗。治疗三天后，她出现疲劳加重、尿量减少和意识模糊。体格检查显示心动过速，心率为130次/分钟，外周水肿和意识迟钝。实验室检查显示白细胞计数为5500/微升，血红蛋白水平为9.6克/分升，血细胞比容为29.6%，血小板计数为13000/微升。外周血涂片可见裂体细胞。弥散性血管内凝血筛查为阴性。血清化学值包括血尿素氮111毫克/分升、肌酐3.8毫克/分升和乳酸脱氢酶（LDH）927国际单位。患者接受了血液透析和治疗性血浆置换（TPE），使用新鲜冰冻血浆（FFP）。第五天后不再需要透析。每天进行TPE，直到第13天血小板计数恢复正常，此后延长治疗间隔，直到第50天LDH水平恢复正常。我们得出结论，顺铂诱导的急性暴发性HUS这种通常致命的类型可以通过使用FFP替代的标准TPE成功治疗。
