Perioperative Management Using Thrombopoietin Receptor Agonists for a Patient with Breast Cancer Associated with ITP—A Case Report—

Abstract

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by thrombocytopenia. Two thrombopoietin receptor agonists (TPO-RA), eltrombopag and romiplostim, have recently been used as the second-line treatment for ITP when the steroid therapy was ineffective. There were few reports on the efficacy and safety of perioperative management using only TPO-RA.

We herein report a rare case of breast cancer with ITP. A 76-year-old woman was diagnosed as having breast cancer with ITP, and then received right total mastectomy + sentinel lymph node dissection. The platelet count was properly controlled by using a TPO-RA (eltrombopag) alone before surgery. The platelet count decreased after the operation, but it was properly controlled by increasing the dose of TPO-RA because no bleeding tendency was observed.

As far as we could review, there were eight cases associated with ITP in which a TPO-RA was perioperatively used ; all of them were not of breast cancer. The surgeries performed electively for breast cancer are usually minimally invasive, and so the preventive use of TPO-RA, which has relatively mild side effects, may be effective as one of the options for perioperative management.