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Idiopathic Thrombocytopenic Purpura Case Studies

Case Studies: Therapeutic Management of Immune Thrombocytopenia

James B. Bussel, MD, reviews 2 cases of immune thrombocytopenia and discusses considerations for optimizing therapy in each scenario.

Therapeutic Management of Immune Thrombocytopenia Case 1

Case:  A 48-year-old woman presenting with unusual bruising

October 2017

  • A 48-year-old woman presents with complaints of bruising after minor bumps, bleeding gums despite regular tooth cleaning, and a recent spontaneous bloody nose; symptom onset about 1 year ago
  • Physical evaluation reveals a woman of normal weight and average height, afebrile, no splenomegaly
  • No personal or family history of cancer, autoimmune disease; no recent viral illnesses; no bone pain or night sweats
  • Current medications: ibuprofen as needed, generic hydrochlorothiazide (HCTZ)
  • Laboratory findings:
    • CBC reveals platelets 28 X 109/L
    • WBCs within normal
    • Renal and hepatic function within normal
  • Diagnosis: idiopathic thrombocytopenic purpura
  • Patient started on a course of prednisone 1 mg/kg for 21 days, then tapered off
    • Platelets: 29 X 109/L
    • Second course of prednisone 1 mg/kg for 21 days

April 2018

  • After 2 courses of prednisone, patient’s platelets have not recovered
    • CBC shows platelets at 28 X 109/L
  • Symptoms of easy bruising and bleeding from gums continue
  • After discussion with patient, she is started on the thrombopoietin receptor agonist (TPO-RA) eltrombopag (PROMACTA), at a dose of 50 mg/day
    • Dose increased to 75 mg/day; last platelet count, 65 X 109/L
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