First successful use of eltrombopag before surgery in a child with MYH9-related thrombocytopenia.
MYH9-related disease (MYH9-RD) is one of the most frequent autosomal-dominant forms of inherited macrothrombocytopenias and is caused by mutations in MYH9 (nonmuscle myosin IIA), the gene coding for the heavy chain of the nonmuscle myosin IIA. Affected individuals can present with isolated thrombocytopenia, and whereas only some will have bleeding events requiring intervention, nearly all will require the use of prophylactic platelet transfusions before surgery. Here we report the first prophylactic use of eltrombopag before surgery in a child with MYH9-RD. Our patient was a 13-year-old girl with an MYH9 S96L missense mutation who required a tympanoplasty due to chronic otitis media. Pretreatment microscopic platelet count was 10 × 10(9)/L. The child was treated with eltrombopag starting 4 weeks before her planned surgery. On the day of surgery her platelet count was 70 × 10(9)/L. She required no platelet transfusions and no abnormal bleeding was reported either during surgery or postoperatively. Given these results, the first reported in a child, we suggest that the use of this thrombopoietic agent should be further evaluated as a useful presurgical prophylactic option in this hereditary thrombocytopenia, thus avoiding the use of platelet transfusions and their associated risks, which include alloimmunization and the transmission of infectious agents.
Assistance Publique-Hôpitaux de Paris, Armand Trousseau Children’s Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France. remi.favier@trs.aphp.fr
Remi
R
Favier
Joffrey
J
Feriel
Marie
M
Favier
Françoise
F
Denoyelle
John A
JA
Martignetti
D000293:Adolescent; D001565:Benzoates / Q000627:therapeutic use*; D002869:Chromosome Aberrations; D005260:Female; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D020409:Molecular Motor Proteins / Q000235:genetics*; D020125:Mutation, Missense; D018995:Myosin Heavy Chains / Q000235:genetics*; D010033:Otitis Media / Q000097:blood / Q000601:surgery*; D010976:Platelet Count; D011300:Preoperative Care; D011720:Pyrazoles / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D013921:Thrombocytopenia / Q000097:blood / Q000188:drug therapy* / Q000235:genetics*; D018058:Tympanic Membrane Perforation / Q000097:blood / Q000601:surgery*; D014433:Tympanoplasty
D001565:Benzoates; D006834:Hydrazines; C103814:MYH9 protein, human; D020409:Molecular Motor Proteins; D011720:Pyrazoles; D053628:Receptors, Thrombopoietin; C082218:MPL protein, human; D018995:Myosin Heavy Chains; C520809:eltrombopag
MYH9-RD; eltrombopag; prophylaxis; thrombocytopenia