2017 Volume 87 Issue Extra1 Pages E125-E128
We report a case of a male infant with refractory immune thrombocytopenia (ITP) treated with romiplostim.
The patient had received intravenous immunoglobulin (IVIg) therapy for ITP since the age of 3 months, but was hospitalized for recurrent thrombocytopenia.
On admission, there was no mucous membrane bleeding. Bone marrow examination, revealed increased megakaryocytes and characteristic findings of ITP. Because oral prednisolone and IVIg had no effect, we decided on observation. However, as he grew, his risk of bleeding for injury increased. We decided to use either a thrombopoietin (TPO) receptor agonist or rituximab. There are few reports of infants receiving TPO receptor agonists, but there are reports of infant deaths after used rituximab, and the remission rate with TPO receptor agonists is better than with rituximab. Therefore, we administered romiplostim, a TPO receptor agonist. We started romiplostim 2 months after ITP recurrence. His platelet count increased to 1×104/μL at 6 weeks after the start of therapy, and reached 20×104/μL without further treatment at 2 years after relapse. We assume his ITP is in remission.
Use of a TPO receptor agonist may be an effective non-operative treatment in refractory infantile ITP.
