Reynolds Samuel Benjamin, Hashmi Hamza, Ngo Phuong, Kloecker Goetz
Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA.
BMJ Case Rep. 2019 Jan 14;12(1):bcr-2018-227717. doi: 10.1136/bcr-2018-227717.
A 61-year-old woman with chronic lymphocytic leukaemia, with Richter's transformation to a diffuse, large, B-cell lymphoma, treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and in complete remission, presented to the hospital after her platelets were found to be 2×10³/µL in outpatient laboratory studies. She initially underwent a platelet transfusion without improvement. This was followed by 4 days of high-dose dexamethasone and intravenous immunoglobulin, which again yielded no meaningful effect. Even a single-dose rituximab failed to achieve a platelet increase after 5 days of monitoring. The patient was then given 2 mg of intravenous vincristine along with a high-dose of dexamethasone and IVIG and demonstrated substantial recovery in platelets to >50×10³/µL within 48 hours. This case study provides an overview of the current management strategies for idiopathic thrombocytopenic purpura that is unresponsive to conventional medical therapy and particularly sheds light on their therapeutic benefits and potential adverse effects.
一名61岁的慢性淋巴细胞白血病女性患者，已发生里氏转化为弥漫性大B细胞淋巴瘤，接受了6个周期的利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松治疗，目前处于完全缓解期。门诊实验室检查发现其血小板计数为2×10³/µL后，她前往医院就诊。她最初接受了血小板输注，但情况并未改善。随后给予了4天的大剂量地塞米松和静脉注射免疫球蛋白，同样没有产生显著效果。即使单剂量利妥昔单抗在监测5天后也未能使血小板计数升高。然后，该患者接受了2mg静脉注射长春新碱以及大剂量地塞米松和静脉注射免疫球蛋白治疗，并在48小时内血小板计数大幅恢复至>50×10³/µL。本病例研究概述了目前对常规药物治疗无反应性的特发性血小板减少性紫癜的管理策略，尤其阐明了其治疗益处和潜在不良反应。
