Gemcitabine-induced hemolytic uremic syndrome in ovarian carcinoma

Multiple chemotherapeutic agents, either alone or in combination, have been implicated in causing hemolytic uremic syndrome (HUS). Gemcitabine has been reported to cause this condition rarely. A 48-year-old Caucasian woman, gravida 3, para 3 (G3P3), was diagnosed with stage III C ovarian carcinoma and after completing numerous chemotherapeutic regimens, she was started on gemcitabine. During her fourth cycle of gemcitabine, she developed generalized anasarca and presented to hospital with hemolytic anemia, thrombocytopenia, and renal failure. A diagnosis of HUS was made, which was confirmed by renal biopsy, and the patient was started on hemodialysis and plasmapheresis. We conclude if a patient has advanced-stage disease and has been heavily treated with chemotherapy before, there is a high risk that, on gemcitabine monotherapy, the patient can develop HUS earlier than expected.