Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Private Veterinary Practice, Thessaloniki, Greece.
Top Companion Anim Med. 2021 Mar;42:100488. doi: 10.1016/j.tcam.2020.100488. Epub 2020 Oct 25.
A 9-year-old, intact male, mixed-breed dog was admitted with a 3-day history of severe thrombocytopenia and bleeding diathesis. Physical examination revealed mucosal and cutaneous petechiae and ecchymoses, melena, and gross hematuria. Clinicopathologic evaluation indicated severe thrombocytopenia, anemia, and panhypoproteinemia. Serology for common endemic vector-borne pathogens was negative and thoracic and abdominal imaging was unremarkable. Bone marrow aspiration cytology revealed aplasia of the megakaryocytic lineage, in the context of a mildly hypoplastic myeloid and a normal erythroid series. A diagnosis of presumptive primary amegakaryocytic immune thrombocytopenia (ITP) was established. Treatment with vincristine, prednisolone, and mycophenolate mofetil along with several whole blood transfusions failed to achieve clinical and clinicopathologic remission. As an adjunct treatment, romiplostim was administered at a cumulative dose of 15 μg/kg, subcutaneously, in 2 sessions, 1 week apart, and complete clinical and hematological remission was noted 8 days postinitiation of romiplostim. Thirty-eight months later, the dog remains clinically healthy with no evidence of hematological relapse. Romiplostim could be a promising adjunctive treatment option in dogs with refractory ITP.
一只 9 岁、未绝育的雄性混血犬，因严重血小板减少和出血倾向病史入院 3 天。体格检查发现黏膜和皮肤瘀点和瘀斑、血便和肉眼血尿。临床病理评估提示严重血小板减少、贫血和全蛋白血症。常见地方性虫媒病原体的血清学检测结果为阴性，且胸腹部影像学检查未见异常。骨髓抽吸细胞学检查显示巨核细胞系发育不良，伴有轻度骨髓增生不良和正常红细胞系列。诊断为疑似原发性巨核细胞免疫性血小板减少症（ITP）。采用长春新碱、泼尼松龙和霉酚酸酯联合治疗，并多次输注全血，但未能达到临床和临床病理缓解。作为辅助治疗，给予罗米司亭，按 15μg/kg 剂量，皮下分 2 次给药，间隔 1 周，在开始罗米司亭治疗 8 天后观察到完全临床和血液学缓解。38 个月后，该犬仍保持临床健康，无血液学复发迹象。罗米司亭可能是治疗难治性 ITP 的一种有前途的辅助治疗选择。
