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Gemcitabine-induced haemolytic uraemic syndrome in pancreatic adenocarcinoma
  1. Adarsh Das1,
  2. Andrew Dean2 and
  3. Tim Clay2
  1. 1 Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
  2. 2 Department of Medical Oncology, Saint John of God Hospital Subiaco, Subiaco, Western Australia, Australia
  1. Correspondence to Dr Adarsh Das, adarshdas7{at}


A woman in her mid-70s with metastatic pancreatic adenocarcinoma presented with fatigue, nausea and bilateral leg swelling, 4 days after an intravenous gemcitabine infusion. Additional examination and laboratory tests showed mild hypertension, low haemoglobin, high lactate dehydrogenase, low platelet count and high serum creatinine. The patient was subsequently diagnosed with haemolytic uraemic syndrome (HUS), and gemcitabine administration was immediately ceased. The patient received a 5-day course of methylprednisolone, with a full recovery being made 10 days after diagnosis. Clinicians should be aware of the rare but serious complication of gemcitabine-induced HUS (GiHUS), as early diagnosis and management, which includes prompt discontinuation of gemcitabine, are crucial in promptly resolving this condition. This case report describes one treatment that can be used for the treatment of GiHUS, while briefly covering some other novel treatments that have been described in other studies.

  • pancreatic cancer
  • chemotherapy
  • gemcitabine
  • haemolytic uraemic syndrome

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  • Contributors AnD: performed the renal function tests and subsequent blood tests. AdD: wrote the background and the discussion. AnD: wrote the case presentation and investigations. TC wrote the treatment, differential diagnosis, treatment and follow-up. AdD and AnD: made attempts to contact the patient’s family. AdD, AnD and TC: analysed and interpreted the patient’s data and blood results; were major contributors in writing the manuscript; read and approved the final manuscript; drafted the work for important intellectual content; approved the final version to be published; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.