Therapeutic Management of Immune Thrombocytopenia Case 2 - Episode 2
James B. Bussel, MD:In addition to the well-known risk of overwhelming post splenectomy sepsis, which is a lifetime event, there’s a very small risk of problems with the actual procedure even when done laparoscopically. And there’s a small increased risk of stroke, 1.5­-fold times that of other patients with ITP not undergoing splenectomy. So, these are reasons that people hold off, in addition to the fact that there may be other long-term effects that over time will mount up and be significant.
If we consider other factors in her case, she may well be fatigued. If so, that could be iron deficiency if her menses have been heavy for long enough and/or if she was iron deficient to start with. And she may have issues with thyroid disease, especially if she’s overweight. That may have been 1 of the reasons that she’s overweight in the first place. So, these would certainly need to be tested, and even if they were normal at diagnosis, they would need repeated retesting as time goes on. Because of these issues, she would seem to be particularly good candidate for a TPO agent. And as far as efficacy is concerned, there’s really no difference between eltrombopag and romiplostim. That has been clearly demonstrated in ITP. Therefore, the choice would fall into insurance-related issues, diet-related issues, how she would be able to get her weekly injections, and other considerations like that.
Transcript edited for clarity.
Case: A 44-year-old woman presenting with reddish-purple rash on lower legs