Use of the novel thrombopoietin receptor-agonist romiplostim, in combination with steroids and immunoglobulins for the increase of platelets prior to splenectomy, in refractory immune thrombocytopenia

Abstract

This case report describes a patient with relapsed primary immune thrombocytopenic purpura (ITP), in which splenectomy was not possible due to the persistence of a low platelet count despite treatment with corticosteroids, intravenous immunoglobulins (IVIG) and platelet transfusion treatment. As an attempt to increase platelet count prior to performing splenectomy, the thrombopoietin receptor agonist, romiplostim, was administered in combination with steroids and IVIG. A single administration of romiplostim was found to be markedly effective, allowing a rapid and notable platelet increase, required for a well tolerated splenectomy. This case confirms the potent activity of romiplostim in ITP, and indicates that patients with recurrent primary ITP who are unresponsive to conventional immunosuppressive therapy may benefit from the addition of a short course of romiplostim.

Effect of Thrombopoietin Receptor Agonists (Romiplostim) on Hepatic Thrombocytopenia in Cirrhotic Male Albino Rats

“…The correction of thrombocytopenia in CLD improves general health by correction of bleeding tendency. This match with many clinical case reports that shown a possible role of Romiplostim in the preparation preliver transplant or prior for invasive therapeutic procedure (Dultz et al, 2011 andSivera et al, 2012). In addition, this improvement in the general health allows and improves effect of other medications used in the treatment of CLD.…”

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

“…Baldini et al described a patient with transient thrombocytosis after using romiplostim to augment platelet count prior to splenectomy in a patient with ITP secondary to non-Hodgkin lymphoma [21]. Similarly, Sivera et al reported a case of transient thrombocytosis after romiplostim was used to augment platelet count prior to splenectomy in a patient with ITP refractory to steroids and IVIG and with significant uterine bleeding [22]. …”

Romiplostim therapy as a second‐line treatment before splenectomy for refractory immune thrombocytopenia in a cirrhotic patient with iatrogenic Cushing syndrome secondary to corticosteroids

“…Many recent clinical case reports have shown a possible role of romiplostim in the preparation preliver transplant or prior for invasive therapeutic procedure .…”