Okazuka Kiyoshi, Masuko Masayoshi, Matsuo Yuji, Miyakoshi Shukuko, Tanaka Tomoyuki, Kozakai Takashi, Kobayashi Hironori, Fuse Kyoko, Shibasaki Yasuhiko, Moriyama Masato, Takizawa Jun, Fuse Ichiro, Toba Ken, Furukawa Tatsuo
Division of Hematology, Niigata Univerisity Medical and Dental Hospital, Japan.
Intern Med. 2013;52(11):1239-42. doi: 10.2169/internalmedicine.52.0080.
A 51-year-old man was admitted due to a severe bleeding tendency. After he was diagnosed with immune thrombocytopenia (ITP), several therapies, including steroids, steroid pulse, vincristine and rituximab, were administered; however, the patient's bleeding symptoms were not sufficiently controllable with these treatments. Subsequently, a diffuse alveolar hemorrhage was observed. Treatment with a thrombopoietin receptor agonist, romiplostim, was initiated to prevent lethal hemorrhaging, although the efficacy of thrombopoietic receptor agonists in such emergency situations has not been elucidated. The initiation of romiplostim achieved prompt remission in platelets. This case suggests that combination therapy with romiplostim, rituximab and vincristine is effective in cases of newly diagnosed severe therapy-resistant ITP.
一名51岁男性因严重出血倾向入院。在被诊断为免疫性血小板减少症（ITP）后，给予了包括类固醇、类固醇冲击疗法、长春新碱和利妥昔单抗在内的多种治疗；然而，这些治疗未能充分控制患者的出血症状。随后，观察到弥漫性肺泡出血。尽管血小板生成素受体激动剂在这种紧急情况下的疗效尚未阐明，但开始使用血小板生成素受体激动剂罗米司亭进行治疗以预防致命性出血。罗米司亭的使用使血小板迅速缓解。该病例表明，罗米司亭、利妥昔单抗和长春新碱联合治疗对新诊断的严重难治性ITP病例有效。
