Abstract
We report a case of refractory idiopathic thrombocytopenic purpura (ITP) in a patient with upper gingival carcinoma treated by modified radical neck dissection who received a thrombopoietin receptor agonist and γ-globulin before operation to increase the platelet count and control hemostasis. A 58-year-old woman was referred to our hospital because of contact pain of the right palatal molar region. A diagnosis of squamous cell carcinoma was obtained on biopsy. The preoperative laboratory tests showed platelet counts of 1.7〜3.1×104/μL. We planned a partial maxillectomy. Before operation, intravenous immunoglobulin (IVIG) was given for 5 days. However, the platelet count did not increase. Thus, she was given a transfusion of platelets and underwent a partial maxillectomy.
Three months after operation, PET-CT showed metastases to the right cervical lymph nodes. She needed to undergo modified radical neck dissection. Before operation, thrombopoietin receptor agonist and γ-globulin were administered. As a result, the platelet count increased to 14.0×104/μL, and she did not require transfusion of platelets. Thrombopoietin receptor agonist and γ-globulin were suggested to be safe and useful for patients with refractory ITP treated surgically.
