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Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage

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...

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Autores principales: Gellens, Romain, Habchi, Sabrina, Freppel, Sebastien, Couret, David, Iacobelli, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121195/
https://www.ncbi.nlm.nih.gov/pubmed/30210422
http://dx.doi.org/10.3389/fneur.2017.00737
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author Gellens, Romain
Habchi, Sabrina
Freppel, Sebastien
Couret, David
Iacobelli, Silvia
author_facet Gellens, Romain
Habchi, Sabrina
Freppel, Sebastien
Couret, David
Iacobelli, Silvia
author_sort Gellens, Romain
collection PubMed
description 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.
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spelling pubmed-61211952018-09-12 Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage Gellens, Romain Habchi, Sabrina Freppel, Sebastien Couret, David Iacobelli, Silvia Front Neurol Neuroscience 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. Frontiers Media S.A. 2018-01-15 /pmc/articles/PMC6121195/ /pubmed/30210422 http://dx.doi.org/10.3389/fneur.2017.00737 Text en Copyright © 2018 Gellens, Habchi, Freppel, Couret and Iacobelli. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Gellens, Romain
Habchi, Sabrina
Freppel, Sebastien
Couret, David
Iacobelli, Silvia
Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title_full Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title_fullStr Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title_full_unstemmed Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title_short Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
title_sort romiplostim for the emergency management of severe immune thrombocytopenia with intracerebral hemorrhage
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121195/
https://www.ncbi.nlm.nih.gov/pubmed/30210422
http://dx.doi.org/10.3389/fneur.2017.00737
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