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Timeline, from initiation of weekly gemcitabine on April 16 to recovery from HUS after discontinuation of gemcitabine on July 30, showing the changes of hemoglobin level, platelet count, and creatinine level.
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After a cumulative dose of 11,000 mg/m2 gemcitabine, the patient developed HUS evidenced by MAHA with schistocytes seen in peripheral blood smear, decreased haptoglobin level (<0.29 mmol/L), thrombocytopenia, negative direct and indirect Coombs test, and acute kidney injury (Fig. 1).