Romiplostim for management of refractory immune thrombocytopenic purpura in the immediate postpartum period

2020 ◽  
Vol 13 (5) ◽  
pp. e234335
Author(s):  
Ariana Patras ◽  
Reinaldo Figueroa ◽  
Amit P Singh ◽  
Ichchha Madan
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Postpartum Period ◽  
Liver Enzymes ◽  
High Dose ◽  
Chronic Hypertension ◽  
First Line ◽  
Diagnostic Dilemma ◽  
Thrombocytopenic Purpura ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist

We present a case of a pregnant woman with chronic immune thrombocytopenic purpura and chronic hypertension who developed pre-eclampsia with severe features warranting delivery. Her overall clinical picture and liver enzymes improved in the immediate postpartum period, however, aggressively progressing thrombocytopenia posed a diagnostic dilemma to the interdisciplinary care team. After failing to respond to first-line therapies including high-dose corticosteroids and intravenous immunoglobulin, she was successfully managed with a trial of the thrombopoietin receptor agonist, Romiplostim.

scholarly journals Severe immune thrombocytopenic purpura in critical COVID-19: a case report

2020 ◽  
Author(s):  
Valérie Lévesque ◽  
Émilie Milaire ◽  
Daniel Corsilli ◽  
Benjamin Rioux-Massé ◽  
François Martin Carrier
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Immune Thrombocytopenia ◽  
Clinical Manifestations ◽  
High Dose ◽  
New Disease ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Hematological Manifestations

Abstract Purpose: COVID-19 is a new disease with many undescribed clinical manifestations. Material and methods: We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient.Results: A patient presented a severe episode of immune thrombocytopenia (< 10 x 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high dose dexamethasone to observe an increase in platelet count. Conclusion: COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.

scholarly journals Severe Immune Thrombocytopenic Purpura Treated with Plasma Exchange

2012 ◽  
Vol 10 (1) ◽  
pp. 77-82 ◽  
Author(s):  
MR Sigdel ◽  
DS Shah ◽  
MP Kafle ◽  
KB Raut
Keyword(s):  
Platelet Count ◽  
Plasma Exchange ◽  
Immune Thrombocytopenic Purpura ◽  
Low Dose ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
Steroid Resistant ◽  
Low Platelet Count

Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy. KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 85-87 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6922

scholarly journals Balancing Therapy with Thrombopoietin Receptor Agonists and Splenectomy in Refractory Immune Thrombocytopenic Purpura: A Case of Postsplenectomy Thrombocytosis Requiring Plateletpheresis

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Jacquelyn Zimmerman ◽  
Kelly J. Norsworthy ◽  
Robert Brodsky
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Treatment Options ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
Thrombopoietin Receptor Agonists ◽  
Receptor Agonists ◽  
Autoimmune Destruction ◽  
Thrombopoietin Receptor ◽  
Line Of Therapy ◽  
The Ideal

Immune thrombocytopenic purpura (ITP) causes thrombocytopenia through the autoimmune destruction of platelets. Corticosteroids remain the first line of therapy, and traditionally splenectomy has been the second. While the availability of thrombopoietin receptor agonists (TPO-RAs) has expanded treatment options, there is little data for the ideal management of these agents in preparation for splenectomy. Thrombocytosis has been reported after splenectomy in patients treated with TPO-RA preoperatively, with one prior case requiring plateletpheresis for symptomatic thrombocytosis. We present a case report and review of the literature pertaining to this complication and provide recommendations for preventing postsplenectomy thrombocytosis in ITP patients on TPO-RAs.

CP-080 Thrombopoietin receptor agonist treatment in idiopathic thrombocytopenic purpura

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A32.1-A32
Author(s):  
MH García Lagunar ◽  
I Español Morales ◽  
M Martínez Penella ◽  
I Muñoz García ◽  
M Gutiérrez Cívicos ◽  
...  
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Receptor Agonist ◽  
Thrombocytopenic Purpura ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist

scholarly journals Thrombopoietin Receptor Agonist Eltrombopag Prevents Insulin Resistance and Synaptic Pathology via HIF1α/COX2/Sirt1 Signaling Pathway 

2021 ◽  
Author(s):  
he yu ◽  
xuebao wang ◽  
leping liu ◽  
baihui chen ◽  
shuya feng ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Learning And Memory ◽  
Receptor Agonist ◽  
Synaptic Activity ◽  
Sirtuin 1 ◽  
High Dose ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist ◽  
Synaptic Formation

Abstract Background: Insulin resistance has been reported to be closely correlated with the pathogenesis of MHE. The mechanism underlying the effects of thrombopoietin receptor agonist eltrombopag (ELT) on synaptic activity and formation involved in MHE pathogenesis remains unclear. Methods: The effect of ELT on neurodegeneration and insulin resistance was examined in the primary rat neurons and an MHE rat model. Results: We found that the level of thrombopoietin receptor c-MPL (MPL) expression was decreased in MHE brains, and ELT administration improved insulin resistance, alleviated the destruction of synaptic formation and enhanced learning and memory in the MHE rats, indicating the relationship between dowregulated ELT and insulin resistance. Then in vitro, ELT treatment ameliorated the impairment of glucose uptake, indicating the reduction of insulin resistance. High dose of glucose inhibited insulin-stimulated downregulation of Hypoxia-inducible factor-1α (HIF1α) expression, the inhibition of inflammatory response and upregulation of sirtuin-1 (Sirt1), destruction of synaptic formation and activity, which were all reversed by ELT treatment in insulin resistant neurons.Conclusions: These results indicate that ELT is a promising potential therapeutic agent for insulin resistance and defect in learning and memory.

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