Refractory severe idiopathic thrombocytopenia and treatment challenges.
| Autor: | Shahnazi A; Department of Medicine, Lewis Gale Medical Center, Salem, Virginia, USA., Johnston B; Department of Medicine, Lewis Gale Medical Center, Salem, Virginia, USA., Hargrove M; Department of Medicine, Lewis Gale Medical Center, Salem, Virginia, USA., Patolia H; Department of Medicine, Lewis Gale Medical Center, Salem, Virginia, USA., Junko G; Department of Medicine, Lewis Gale Medical Center, Salem, Virginia, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2023 Mar 27; Vol. 85 (4), pp. 973-975. Date of Electronic Publication: 2023 Mar 27 (Print Publication: 2023). |
| DOI: | 10.1097/MS9.0000000000000233 |
| Abstrakt: | Refractory idiopathic thrombocytopenia (ITP) is a disease that does not respond to or relapses after splenectomy, requires treatment to reduce the risk of clinically significant bleeding, and is a challenging case to treat. Presentation of the Case: A 39-year-old male with a history of chronic ITP presented with a platelet count of 1000/µl and prostatitis. He was started on Ciprofloxacin and started intravenous immunoglobulin along with intravenous methylprednisolone. Then Rituximab was started on day fourth. Since his platelet remained 0/µl, Mycophenolate mofetil (Cellcept) was started on day 14th. Next, a dose of Romiplostim on day 19th was given. Eltrombopag (Promacta) and Tavlesse were started on day 23th and platelets rose to 96×10 3 /µl on day 26th and then 418×10 3 /µl. Discussion: Normally, refractory ITP patients who do not respond to first-line treatments require a combination therapy of one to two medicines of the second line, like thrombopoietin receptor agonists. However, this patient's thrombocytopenia neither responded to first-line treatment nor second-line treatment with Promacta/Romiplostin plus immunosuppressives or Tavlesse. Conclusion: Refractory ITP, who has not responded to first-line and second-line treatments, requires treatment with a combination of all first-line and second-line treatments. Furthermore, Promacta, Tavlesse, and Romiplostim have a big role to play in helping the patient. Competing Interests: The authors have no competing interests to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.) |
| Databáze: | MEDLINE |
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