Open AccessHemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor
Author(s) -
Noémie Worbe,
Louise Damian,
Véronique Le Cam-Duchez,
H. Lévesque,
Pierre Michel,
Elske Quak
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000027455
Subject(s) - medicine , disseminated intravascular coagulation , radionuclide therapy , anemia , gastroenterology , pathology
Rationale: Peptide receptor radionuclide therapy with 177 Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure. Patients concerns: We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177 Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome. Diagnoses: We made the diagnosis of acute disseminated intravascular coagulation. Intervention: Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved. Outcomes: Metabolic imaging 5 months after the 177 Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC. Lessons: Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177 Lu-Dotatate peptide receptor radionuclide therapy.