Therapeutic Management of Immune Thrombocytopenia Case 2

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Therapeutic Management of Immune Thrombocytopenia

Case: A 44-year-old woman presenting with reddish-purple rash on lower legs

February 2017

  • Patient presents with complaints of a reddish-purple rash on her lower legs and “constant” bruises appearing “spontaneously” without her remembering any trauma
  • Physical evaluation reveals:
    • The rash to be petechiae (subcutaneous bleeding)
    • Slightly overweight (BMI = 26.5 kg/m2)
    • Patient is afebrile, with no splenomegaly
  • When asked, reports her menstrual flow is unusually heavy, but says she was evaluated for and had no evidence of fibroids or endometriosis
  • No personal or family history of cancer; no recent viral illnesses; no bone pain
  • Current medications: no chronic medications; acetaminophen as needed; multivitamin
  • Laboratory findings:
    • CBC reveals platelets 21 X 109/L
    • All other findings with normal range
    • Negative forH pylori, HIV, and HCV
  • Diagnosis: chronic ITP
    • Started course of prednisone 1 mg/kg X 21 days, then tapered off; at evaluation, platelets: 27 X 109/L
    • Second course of prednisone 1 mg/kg X 21 days; at evaluation, platelets still <30
    • Third course of prednisone 1 mg/kg X 21 days; at evaluation, platelets still <30

February 2018

  • &ldquo;Rash&rdquo; partly resolved, bruising still present
  • Patient complains of weight gain on treatment and trouble sleeping
  • After discussion with patient, she is started on eltrombopag (PROMACTA), at a dose of 50 mg/day
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