Watanabe Reiko, Tabayashi Takayuki, Tomikawa Tatsuki, Sagawa Morihiko, Anan-Nemoto Tomoe, Kimura Yuta, Takahashi Yasuyuki, Tokuhira Michihide, Otaki Satoshi, Oi Hidenori, Sawano Makoto, Sugiyama Satoshi, Kizaki Masahiro
Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
Laboratory of Functional Analysis in silico, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Int J Hematol. 2017 Jan;105(1):100-103. doi: 10.1007/s12185-016-2094-z. Epub 2016 Oct 5.
Thrombopoietin receptor (TPO-R) agonists have been shown to be effective in refractory chronic immune thrombocytopenia (ITP); however, their efficacy in patients under critical care is not known. We report the case of a female patient with a newly diagnosed ITP who experienced severe bleeding from an external wound. The patient was administered the standard treatments for ITP, which are high-dose intravenous immunoglobulin (IVIg) and corticosteroids. However, following failure of these treatments, we administered romiplostim on day 6 after the onset of ITP. On day 6 after the initiation of romiplostim, there was improvement in platelet count and bleeding tendency. We were subsequently able to perform a splenectomy successfully. The efficacy of TPO-R agonists in ITP has been reported in several situations, including before surgery in an ITP patient; however, the use of TPO-R for arterial bleeding with shock has not been reported. To our knowledge, the present article is a rare case report of the use of a TPO-R agonist in a patient with critical artery injury. Our data suggest that the early use of romiplostim is effective in emergency cases of newly diagnosed ITP with life-threatening bleeding, which is refractory to standard treatment.
血小板生成素受体（TPO-R）激动剂已被证明对难治性慢性免疫性血小板减少症（ITP）有效；然而，其在重症监护患者中的疗效尚不清楚。我们报告了一例新诊断为ITP的女性患者，该患者因外伤出现严重出血。患者接受了ITP的标准治疗，即大剂量静脉注射免疫球蛋白（IVIg）和皮质类固醇。然而，这些治疗失败后，我们在ITP发病后第6天给予了罗米司亭。在开始使用罗米司亭后的第6天，血小板计数和出血倾向有所改善。随后我们成功地进行了脾切除术。TPO-R激动剂在ITP中的疗效已在多种情况下得到报道，包括在ITP患者手术前；然而，尚未有关于TPO-R用于伴有休克的动脉出血的报道。据我们所知，本文是关于TPO-R激动剂用于严重动脉损伤患者的罕见病例报告。我们的数据表明，早期使用罗米司亭对新诊断的伴有危及生命出血且对标准治疗无效的ITP紧急情况有效。
