Abstract
Currently, we lack well-established guidelines for the emergency management of severe immune thrombocytopenia (ITP) with life-threatening bleeding. We now report the management of two patients with severe ITP, complicated by substantial cerebral hemorrhage, requiring urgent surgery due to refractory intracranial hypertension. To rapidly boost platelet counts (PCs), corticosteroids, intravenous immunoglobulin, and iterative platelet transfusions were given; all were ineffectual. Romiplostim, a thrombopoietin receptor agonist, was then administered as an “on demand therapy,” with the result that a rapid and sustained increase of PCs was achieved, thus allowing for postoperative hemostasis. Both patients recovered good neurological condition, suggesting the potential utility of romiplostim, in combined therapy, for the emergency management of severe ITP.
Highlights
Intracerebral hemorrhage (ICH) is a rare (1.4% in adults,
ITP, as newly defined, is an acquired disease characterized by a platelet count (PC) less than 100 × 109/L mediated by immune system disruption
We describe two cases illustrating the use of romiplostim as “on demand therapy” for hemorrhagic stroke causing intracranial hypertension, in the setting of primary or secondary ITP
Summary
Intracerebral hemorrhage (ICH) is a rare (1.4% in adults,
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