ABSTRACTS POSTERS WETENSCHAPSDAG SFG 2012 Thrombotic microangiopathy following administration of docetaxel and zolendronic acid in a patient with castrate refractory prostate cancer (CRPC). Manon J.M. van Oosten1 , Yvonne C. Schrama1 , Egbert R. Boevé2 1 Department of Internal Medicine, Sint Franciscus Gasthuis, 2 Department of Urology Sint Franciscus Gasthuis. BACKGROUND: Thrombotic microangiopathy (TMA) is a rare but severe condition, characterised by microangiopathic haemolytic anemia and thrombocytopenia with or without renal and neurologic abnormalities. CASE REPORT: In a 66-year old patient with CRPC treatment with docetaxel and zoledronic acid was initiated. Prior to treatment there was mild anemia and no signs of hemolysis. Two days after administration of docetaxel and zoledronic acid, he was admitted because of severe fatigue, and a slightly altered mental state. Blood count showed normocytic anemia (hemoglobin, 5.7 mmol/l), thrombocytopenia (platelets, 10x10^9/l) and red cell fragmentation (schistocytes) whilst leukocyte-count was normal. Further evaluation showed a Coombs-negative hemolysis with haptoglobin 0.06 gr/l and renal failure (serum creatinine 471 umol/l). TMA triggered by docetaxel or zoledronic acid was considered. Dialysis and plasma infusion was initiated. No plasma exchange was done based on the assumption that TMA was triggered by treatment and literature is inconclusive with respect to plasma exchange for drug-induced TMA. After a few days, the patient refused further treatment and died ten days after admission. DISCUSSION: TMA is a rare complication in patients with advanced cancer as well chemotherapy-related. Previously a relation with Mitomycin C, Cisplatin and Gemcitabine has been described. A few cases have been reported on docetaxel (n=2) and zoledronic acid (n=3) with a suggestive relation to the occurrence of TMA. In case of multiple triggers, no discriminatory tests are available, although the close timerelation with the administration of docetaxel and zoledronic acid, makes disseminated cancer a less likely cause. Level of ADAMTS 13 activity became available after the patient passed away but was normal (72%). In drug related TMA, less pronounced reductions or normal levels have been noted what makes it not a good diagnostic tool although low levels can be informative. Testing of ADAMTS 13 should not be used to confirm the diagnosis. This is one of the first cases reporting the occurrence of TMA after administration of docetaxel and zoledronic acid. Oncologist and nephrologists should be aware of this untoward side effect. Reductie van colorectale naadlekkages door steunhechtingen. Een experimenteel model. R.P.M. Gadiot1 , K. Vakalopoulos2 , G.H.H. Mannaerts1 , J.F. Lange2 1 Afdeling Heelkunde, Sint Franciscus Gasthuis, Rotterdam 2 Afdeling experimentele Chirurgie, Erasmus Medisch Centrum, Rotterdam. INLEIDING: Naadlekkage is een gevreesde complicatie na colorectale chirurgie. Als er dehiscentie van de anastomose optreedt zal er vocht en faecaal materiaal in de peritoneale ruimte kunnen komen wat kan leiden tot sepsis. De exacte pathofysiologie is onbekend. Een mogelijke oorzaak zou de verhoging van intraluminale druk door passerend faecaal , Paul Hamberg1 . 111 WETENSCHAPPELIJK jaarverslag 2012 Pagina 110
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