Gellens Romain, Habchi Sabrina, Freppel Sebastien, Couret David, Iacobelli Silvia
Neurocritical Care Unit, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, France.
Department of Neurosurgery, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, France.
Front Neurol. 2018 Jan 15;8:737. doi: 10.3389/fneur.2017.00737. eCollection 2017.
Currently, we lack well-established guidelines for the emergency management of severe immune thrombocytopenia (ITP) with life-threatening bleeding. We now report the management of two patients with severe ITP, complicated by substantial cerebral hemorrhage, requiring urgent surgery due to refractory intracranial hypertension. To rapidly boost platelet counts (PCs), corticosteroids, intravenous immunoglobulin, and iterative platelet transfusions were given; all were ineffectual. Romiplostim, a thrombopoietin receptor agonist, was then administered as an "on demand therapy," with the result that a rapid and sustained increase of PCs was achieved, thus allowing for postoperative hemostasis. Both patients recovered good neurological condition, suggesting the potential utility of romiplostim, in combined therapy, for the emergency management of severe ITP.
目前，我们缺乏针对伴有危及生命出血的严重免疫性血小板减少症（ITP）进行应急管理的完善指南。我们现报告两例严重ITP患者的治疗情况，这两名患者并发大量脑出血，因难治性颅内高压而需要紧急手术。为迅速提高血小板计数（PCs），给予了皮质类固醇、静脉注射免疫球蛋白和反复的血小板输注；但所有这些措施均无效。随后给予促血小板生成素受体激动剂罗米司亭作为“按需治疗”，结果PCs迅速且持续升高，从而实现了术后止血。两名患者均恢复了良好的神经状态，这表明罗米司亭在联合治疗中对严重ITP应急管理具有潜在效用。
