THA in Patients with Idiopathic Thrombocytopenic Purpura (ITP): A Case Report

Suzuki, Kôji; Kawachi, Sadaomi; Nanke, Hideki; Ito, Takayoshi

doi:10.2185/jrm.6.81

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…To increase the number of platelets before an invasive surgery, high-dose intravenous immunoglobulin (IVIG) therapy is commonly used. To date, there have been few reported ITP cases in which high-dose IVIG therapy was administered before an invasive surgery [13–15]. Imbach et al [16] suggested administering 400 mg/kg/day of complete molecular model immunoglobulin for 5 days.…”

Section: Discussionmentioning

confidence: 99%

Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report

et al. 2019

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Background Patients with idiopathic thrombocytopenic purpura (ITP) have low platelet counts and an increased risk of complications. Therefore, these patients generally require high-dose immunoglobulin therapy and platelet transfusion. However, thrombopoietin receptor agonists (TPO-RAs) have recently become available for use in the preoperative treatment strategy for intractable ITP. Recent studies have also reported radiofrequency ablation (RFA) or tissue biopsy as perioperative management for thrombocytopenia using TPO-RA. However, no report has described the use of TPO-RA in a case of hepatectomy. Case presentation A 76-year-old man presented with intrahepatic cholangiocarcinoma (IHCC) complicated with ITP. His platelet count was 3.5 × 10 4 /μL. To increase platelet levels prior to surgery, romiplostim was administered subcutaneously (70 μg per week for 3 weeks) and eltrombopag was administered orally (25 mg per day for 23 days), as TPO-RA. His platelet count increased to 14.1 × 10 4 /μL. The patient was successfully and safely treated with left hemi-hepatectomy and TPO-RA as preoperative platelet management. Conclusions This case suggests that TPO-RA can be effective, and could serve as a new treatment option in the preoperative management of ITP.

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Section: Discussionmentioning

confidence: 99%

Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report

et al. 2019

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“…Suzuki et al [ 19 ] reported a case of ITP accompanied by steroid-induced avascular necrosis of the femoral head who underwent THA; preoperative platelet count was 25,000/μL. After administration of high gamma-globulin dose and platelet transfusion, preoperative platelet levels reached 94,000/μL.…”

Section: Discussionmentioning

confidence: 99%

Multiple total hip arthroplasties in refractory immune thrombocytopenic purpura

Tang¹,

Shi³

et al. 2018

Medicine

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Rationale:Refractory immune thrombocytopenic purpura (RITP) manifests as low platelet count, with a high risk of hemorrhage, treatment difficulty, and high mortality. Total hip arthroplasty (THA) in RITP is rarely reported. This study aimed to evaluate multiple THAs or revision total hip arthroplasties (RTHAs) in RITP.Patient concerns:The male patient with RITP was 54-year-old patient and hospitalized on September 21, 2009, with the main complaint of bilateral hip pain after traveling for 2 weeks. The patient had a history of ITP for 16-years, with no response to hormone therapy (after adequate hormone therapy, platelet count persistently remained below 30 × 109/L). Two year prior to visit, the patient underwent splenectomy, and postoperative platelet persistently fluctuated around 10 to 20 × 109/L. The patient did not undergo regular reexaminations, and declined immunosuppressants.Diagnoses:Femoral neck fracture; Refractory immune thrombocytopenic purpura (RITP).Interventions:A RITP patient with femoral neck fracture received 2 THAs and 1 RTHA. First THA indication was significant left dislocation of Garden III type. RTHA was performed following prosthetic loosening after left total hip arthroplasty. The second THA was prompted by non-healing of the old fracture, significant pain, and a low Harris score. Platelet count remained <20 × 109/L, and conventional drugs, splenectomy, and platelet transfusion had no effects. A large gamma-globulin dose was administered preoperatively. When platelet increased to 75 × 109/L, 2 THAs and 1 RTHA were successfully completed.Outcomes:Postsurgery, conventional management was applied; no severe complications occurred. The wound was well healed, with platelet count reduced to <15 × 109/L at hospital discharge. The patient recovered, with a Harris score >80 at 1 year postsurgery.Lessons:Extremely low platelet count is a contraindication of surgery. In this patient, preoperative platelet count was <100 × 109/L. Extended disease course and multiple operations lowered platelet count, and increased risk in surgery. However, high postoperative gamma-globulin dose impacted therapy, and all surgeries were successful, with no severe complications. The wound healed well, and the quality of life was significantly improved, demonstrating the feasibility and safety of this surgery. Multiple THA or RTHA surgeries are feasible and safe for RITP patients.

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“…Although her platelet count was 25,000/ μ L, her platelet count increased to 94,000/ μ L just before the operation with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Therefore, THA was performed by increasing her platelet count [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis in a Patient with Severe Platelet Deficiency due to Liver Cirrhosis and Immune Thrombocytopenic Purpura

Hama

Inori

Momose

et al. 2015

Case Reports in Orthopedics

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Rapidly destructive coxarthrosis (RDC) causes rapid and extreme destruction of the hip joint, which was reported by Postel and Kerboull. RDC is commonly unilateral and occurs mostly in elderly women. Immune thrombocytopenic purpura (ITP) is characterized by a low platelet count that is the result of both immune-mediated platelet destruction and suppression of platelet production. In patients with ITP undergoing surgery, bleeding associated with a low preoperative platelet count can lead to unsuccessful outcomes. To the best of our knowledge, there has been only one report describing total hip arthroplasty (THA) for patients with ITP and there have been no reports of THA for RDC with a very low platelet count due to liver cirrhosis (LC) and ITP. We report the case of a patient who had right RDC and a very low platelet count due to LC and ITP in whom THA was successfully performed. Furthermore, this case was also unique in that her platelet count increased after THA. THA for right RDC might resolve ITP by relieving inflammation of the right hip since her platelet count recovered after THA.

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THA in Patients with Idiopathic Thrombocytopenic Purpura (ITP): A Case Report

Cited by 5 publications

References 5 publications

Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report

Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report

Multiple total hip arthroplasties in refractory immune thrombocytopenic purpura

Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis in a Patient with Severe Platelet Deficiency due to Liver Cirrhosis and Immune Thrombocytopenic Purpura

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