PMC6875012_01
Platelet count over time for the two episodes of thrombocytopenia from oxaliplatin and irinotecan infusion with subsequent recovery.
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Immediately following the first cycle of irinotecan, the patient again developed rectal bleeding, and on repeat, blood work was found to have a severe drop in platelets from 136,000/muL to 6,000/muL within 24 hours following the completion of the FOLFIRI infusion (Figure 1).
Detection of oxaliplatin-dependent platelet antibodies by flow cytometry. Platelets show high IgG binding when incubated with the patient's serum in the presence of oxaliplatin (0.1 mg/mL) (light gray histogram on the right) compared to platelets incubated with buffer/no drug present (dark histogram in the center). The numbers above each histogram are the median fluorescence intensity (MFI) values.
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Interestingly, the patient's serum also showed positive reactions detected by flow cytometry in the absence of any drug but was also potentiated in the presence of oxaliplatin (Figure 2) and irinotecan.