title: Use of the novel thrombopoietin receptor-agonist romiplostim, in combination with steroids and immunoglobulins for the increase of platelets prior to splenectomy, in refractory immune thrombocytopenia:  a case report.
abstract: This case report describes a patient with relapsed primary immune thrombocytopenic purpura (ITP), in which splenectomy was not possible due to the persistence of a low platelet count despite treatment with corticosteroids, intravenous immunoglobulins (IVIG) and platelet transfusion treatment. As an attempt to increase platelet count prior to performing splenectomy, the thrombopoietin receptor agonist, romiplostim, was administered in combination with steroids and IVIG. A single administration of romiplostim was found to be markedly effective, allowing a rapid and notable platelet increase, required for a well tolerated splenectomy. This case confirms the potent activity of romiplostim in ITP, and indicates that patients with recurrent primary ITP who are unresponsive to conventional immunosuppressive therapy may benefit from the addition of a short course of romiplostim.
authors.affiliation: S.C.D.U. Ematologia e Terapie Cellulari, A.O. Ord. Mauriziano-Umberto I, Torino, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Sivera
authors.forename: Marco
authors.initials: M
authors.lastname: Ruella
authors.forename: Angela
authors.initials: A
authors.lastname: Gueli
authors.forename: Huijing
authors.initials: H
authors.lastname: Hu
authors.forename: Muhamed
authors.initials: M
authors.lastname: Wade
authors.forename: Corrado
authors.initials: C
authors.lastname: Tarella
mesh_terms: D000328:Adult; D001792:Blood Platelets / Q000187:drug effects*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013156:Splenectomy / Q000379:methods; D013256:Steroids / Q000627:therapeutic use*; D013926:Thrombopoietin / Q000627:therapeutic use*
chemical_list: D007136:Immunoglobulins; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013256:Steroids; D013926:Thrombopoietin; C488777:romiplostim