Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 531-537
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.531
Gemcitabine-induced haemolytic uremic syndrome, although infrequent, can it be prevented: A case report and review of literature
Esther U Cidon, Pilar A Martinez, Tamas Hickish
Esther U Cidon, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth BH7 7DW, United Kingdom
Pilar A Martinez, Department of Oncology, Clinical University Hospital, Valladolid 47003, Spain
Tamas Hickish, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust and Bournemouth University, Bournemouth BH7 7DW, United Kingdom
Author contributions: Cidon EU contributed to the conception of this paper and design of the article; Cidon EU and Martinez PA equally contributed to the literature review and analysis, drafting, critical revision and editing, and approval of the final version; Hickish T has contributed to critical revision, approval of the final version and as English native speaker, has reviewed and edited the language when needed.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: The authors state that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Esther U Cidon, MD, MSc, PhD, Doctor, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Castle Lane East, Bournemouth BH7 7DW, United Kingdom.
Telephone: +44-1202-303626 Fax: +44-1202-704467
Received: May 5, 2018
Peer-review started: May 5, 2018
First decision: July 9, 2018
Revised: September 8, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 26, 2018
Case characteristics

A 66-year-old female developed a significant renal impairment and anaemia while receiving adjuvant Gemcitabine.

Clinical diagnosis

She was diagnosed with haemolytic uremic syndrome.

Laboratory diagnosis

Her laboratory tests showed haemolysis and ruled out any myelotoxicity.

Imaging diagnosis

An electrocardiogram showed a NSTEMI with widespread T-wave inversion. A renal US did not show any evidence of lesion or cortical damage.

Pathological diagnosis

Although considered a renal biopsy, this was finally declined.

Differential diagnosis

Myelotoxicity and general decline with low intake and dehydration but these were ruled out immediately after receiving results showing haemolysis. Myocardial infarction as the cause but ruled out after parameters showing haemolysis, and considered a consequence of the haemolysis as part of the thrombotic microangiopathy (TMA).


Steroids were tried and she was also started on aspirin. Haemodialysis was needed.

Term explanation

HUS: Haemolytic uremic syndrome; TMA: Thrombotic microangiopathy.

Experiences and lessons

Subtle signs such as increase level of serum creatinine or a significant drop in haemoglobin should flag an alert in patients on Gemcitabine. Although it is unknown if by withholding Gemcitabine this would be able to stop or minimize the damage already initiated, this should be done until all the laboratory workup to confirm or dismiss the diagnosis has been performed and received.