Internal Medicine and Hematology Department, Ain Shams University, Cairo, Egypt.
J Gastroenterol Hepatol. 2013 Feb;28(2):335-41. doi: 10.1111/j.1440-1746.2012.07246.x.
Patients infected with hepatitis C virus (HCV) often develop chronic liver disease, liver cirrhosis and concurrent thrombocytopenia, which manifests as decreased platelet counts and bleeding complications. Romiplostim, a thrombopoietin mimetic peptibody that stimulates the thrombopoietin receptor, has been used as a treatment for primary immune thrombocytopenia. We monitored the efficacy of preoperative romiplostim over 90 days in 35 male patients with chronic hepatitis C, liver cirrhosis and thrombocytopenia secondary to HCV infection.
Romiplostim was administered at 2 μg/kg Q1W for a maximum of one month with a target platelet count of 70 × 10(9)/L as a prerequisite for planned surgeries. Bone marrow aspirate was collected at baseline and at the end of the study, along with liver and kidney function assessments. A complete blood count was performed every third day throughout the study period.
A rapid response to romiplostim therapy was observed, with 33/35 patients achieving platelet counts ≥ 70 × 10(9)/L and thereby eligible for surgery. An initial mean platelet count of 31 × 10(9)/L increased to a maximum peak range of 73-240 × 10(9)/L, occurring between days 18 and 39. The reticulin bone marrow grade remained negative in all patients. Surgical interventions were associated with no postoperative bleeding or thrombotic complications.
Preoperative romiplostim administration may represent a viable alternative to increase platelet counts to a level acceptable for elective surgical interventions in patients with chronic liver disease and severe thrombocytopenia secondary to HCV infection who are unresponsive to standard therapy. Further studies in larger numbers of patients and over a longer period of time are warranted.
感染丙型肝炎病毒（HCV）的患者常发展为慢性肝病、肝硬化和并发血小板减少症，表现为血小板计数减少和出血并发症。罗米司亭是一种模拟促血小板生成素的肽结合物，可刺激促血小板生成素受体，已被用于治疗原发性免疫性血小板减少症。我们监测了 35 名慢性丙型肝炎、肝硬化和 HCV 感染所致血小板减少症的男性患者，在术前 90 天内使用罗米司亭的疗效。
罗米司亭以 2 μg/kg Q1W 给药，最长 1 个月，目标血小板计数为 70×10(9)/L，作为计划手术的前提。在基线和研究结束时采集骨髓抽吸物，并评估肝肾功能。整个研究期间，每三天进行一次全血细胞计数。
观察到罗米司亭治疗的快速反应，35 例患者中有 33 例血小板计数≥70×10(9)/L，有资格进行手术。初始平均血小板计数为 31×10(9)/L，增加至最高峰值范围 73-240×10(9)/L，发生在第 18 天至 39 天之间。所有患者的网状骨骨髓分级均为阴性。手术干预与术后无出血或血栓并发症相关。
术前给予罗米司亭可能是一种可行的替代方案，可以增加血小板计数，使慢性肝病和 HCV 感染所致严重血小板减少症患者的血小板计数达到可接受的水平，从而可进行择期手术干预。需要在更多患者中进行更长时间的进一步研究。
