Refractory immune thrombocytopenia (ITP) with suspected Evans syndrome requiring quadruple therapy

Oluwatosin Bewaji

doi:10.36013/jrdod.v1i.31

Abstract

Immune thrombocytopenia (ITP) is a common cause of acquired thrombocytopenia in children, second only to chemotherapy-induced thrombocytopenia.[1] Most patients respond well to first line therapies, however about there is a high rate of relapse in initially responsive patients.[2] We report a case of recurrent severe form of ITP who failed a re-trial of first line therapies and required second line treatments via a quadruple therapy of immunosuppressants. This case is not only unique due to the aggressive treatment required, but also because patient also had investigation results suggestive of autoimmune hemolytic anemia (AIHA) raising suspicion of Evans Syndrome.

Highlights

Immune thrombocytopenia (ITP) is a common cause of acquired thrombocytopenia in children, second only to chemotherapy-induced thrombocytopenia [1]
We report a case of recurrent severe form of ITP that failed a re-trial of first-line therapies and required second-line treatments that included a quadruple therapy regimen
This case outlines the aggressive treatment required in treating refractory ITP, but it is unique because the patient had investigation results suggestive of autoimmune hemolytic anemia (AIHA), raising suspicion of Evans Syndrome

Summary

Introduction

Immune thrombocytopenia (ITP) is a common cause of acquired thrombocytopenia in children, second only to chemotherapy-induced thrombocytopenia [1]. We report a case of recurrent severe form of ITP that failed a re-trial of first-line therapies and required second-line treatments that included a quadruple therapy regimen. This case outlines the aggressive treatment required in treating refractory ITP, but it is unique because the patient had investigation results suggestive of autoimmune hemolytic anemia (AIHA), raising suspicion of Evans Syndrome.

Results

Conclusion