strontium-radioisotopes and Disseminated-Intravascular-Coagulation

Strontium-89 is effective in the palliation of bone pain caused by skeletal metastases. Its primary side effect is mild thrombocytopenia that typically recovers in 3 or 4 months. Subclinical disseminated intravascular coagulation is reported to be present in approximately 10% to 20% of patients with advanced prostate cancer. These patients may be at increased risk for severe marrow depression after radionuclide therapy for bone pain palliation. This report describes a patient with painful bony metastases resulting from prostate carcinoma. He had a normal platelet count and no clinical evidence of a coagulation disorder at the time of strontium-89 therapy, and a severe disseminated intravascular coagulation developed and lead to death after treatment. A normal platelet count before strontium-89 therapy does not preclude subsequent disseminated intravascular coagulation, and we support the Society of Nuclear Medicine's bone pain treatment procedure guideline that patients referred for bone palliation should be screened for disseminated intravascular coagulation before therapy.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Disseminated Intravascular Coagulation; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

Topics: Bone Neoplasms; Disseminated Intravascular Coagulation; Humans; Male; Palliative Care; Prostatic Neoplasms; Strontium Radioisotopes

A patient with metastatic prostate cancer was found to have low-grade disseminated intravascular coagulation (DIC). He had significant bone pain despite external-beam radiotherapy and was given 89Sr with subsequent thrombocytopenia and epistaxis. The patient died from generalized hemorrhage 36 days postinjection. Although it is not possible to establish a causal relationship between the 89Sr and DIC, practitioners should be alert to complications associated with the primary disorder which might occur at a time to raise concern about the intervention.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Disseminated Intravascular Coagulation; Epistaxis; Fatal Outcome; Humans; Male; Prostatic Neoplasms; Strontium Radioisotopes; Thrombocytopenia