You are here

Article Text

Article menu

Download PDFPDF

Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Rescue therapy for acute idiopathic thrombocytopenic purpura unresponsive to conventional treatment
Free
  1. Samuel Benjamin Reynolds1,
  2. Hamza Hashmi2,
  3. Phuong Ngo2 and
  4. Goetz Kloecker2
  1. 1 Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
  2. 2 Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA
  1. Correspondence to Dr Samuel Benjamin Reynolds, samuel.reynolds{at}louisville.edu

Abstract

A 61-year-old woman with chronic lymphocytic leukaemia, with Richter’s transformation to a diffuse, large, B-cell lymphoma, treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and in complete remission, presented to the hospital after her platelets were found to be 2×10³/µL in outpatient laboratory studies. She initially underwent a platelet transfusion without improvement. This was followed by 4 days of high-dose dexamethasone and intravenous immunoglobulin, which again yielded no meaningful effect. Even a single-dose rituximab failed to achieve a platelet increase after 5 days of monitoring. The patient was then given 2 mg of intravenous vincristine along with a high-dose of dexamethasone and IVIG and demonstrated substantial recovery in platelets to >50×10³/µL within 48 hours. This case study provides an overview of the current management strategies for idiopathic thrombocytopenic purpura that is unresponsive to conventional medical therapy and particularly sheds light on their therapeutic benefits and potential adverse effects.

  • haematology (incl blood transfusion)
  • malignant and benign haematology
  • pathology

https://doi.org/10.1136/bcr-2018-227717

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Patient consent for publication Obtained.

    • Contributors SBR, as the primary author of this manuscript, had a large role in writing the manuscript, specifically in acquiring data from the most relevant studies and incorporating such data into the manuscript to support and/or refute our arguments in to be as objective as possible. HH played an important role in the conception, design and construction of this manuscript, including selecting which content to highlight, use of proper research language. He also played a small role in data interpretation. PN played a major role in writing the manuscript, particularly the case section, and in interpreting data that would be presented in figures. She also had a role in manuscript design. GK played a supervisory role as the project’s principal investigator, and oversaw the interpretation and analysis of collected data. He was also essential in connecting the current literature to our own patient’s case, which resulted in effective translational care for the patient and for communication of ideas and learning through the manuscript.

    • Funding The authors have not declared a specific this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.