title: Successful early romiplostim use in a case of severe immune thrombocytopenia with critical carotid arterial injury.
abstract: Thrombopoietin receptor (TPO-R) agonists have been shown to be effective in refractory chronic immune thrombocytopenia (ITP); however, their efficacy in patients under critical care is not known. We report the case of a female patient with a newly diagnosed ITP who experienced severe bleeding from an external wound. The patient was administered the standard treatments for ITP, which are high-dose intravenous immunoglobulin (IVIg) and corticosteroids. However, following failure of these treatments, we administered romiplostim on day 6 after the onset of ITP. On day 6 after the initiation of romiplostim, there was improvement in platelet count and bleeding tendency. We were subsequently able to perform a splenectomy successfully. The efficacy of TPO-R agonists in ITP has been reported in several situations, including before surgery in an ITP patient; however, the use of TPO-R for arterial bleeding with shock has not been reported. To our knowledge, the present article is a rare case report of the use of a TPO-R agonist in a patient with critical artery injury. Our data suggest that the early use of romiplostim is effective in emergency cases of newly diagnosed ITP with life-threatening bleeding, which is refractory to standard treatment.
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan. reikow@saitama-med.ac.jp.
authors.forename: Reiko
authors.identifier: http://orcid.org/0000-0003-4655-4407
authors.initials: R
authors.lastname: Watanabe
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tabayashi
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Tomikawa
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Morihiko
authors.initials: M
authors.lastname: Sagawa
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Tomoe
authors.initials: T
authors.lastname: Anan-Nemoto
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Michihide
authors.initials: M
authors.lastname: Tokuhira
authors.affiliation: Laboratory of Functional Analysis in silico, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Otaki
authors.affiliation: Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oi
authors.affiliation: Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: Department of Hematology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kizaki
mesh_terms: D000368:Aged; D020212:Carotid Artery Injuries / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013926:Thrombopoietin / Q000627:therapeutic use*
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim
keywords: External wound; Immune thrombocytopenia; Romiplostim; Thrombopoietin receptor agonists