Therapeutic Management of Immune Thrombocytopenia Case 2
Therapeutic Management of Immune Thrombocytopenia
Case: A 44-year-old woman presenting with reddish-purple rash on lower legs
February 2017
- Patient presents with complaints of a reddish-purple rash on her lower legs and “constant” bruises appearing “spontaneously” without her remembering any trauma
- Physical evaluation reveals:
- The rash to be petechiae (subcutaneous bleeding)
- Slightly overweight (BMI = 26.5 kg/m2)
- Patient is afebrile, with no splenomegaly
- When asked, reports her menstrual flow is unusually heavy, but says she was evaluated for and had no evidence of fibroids or endometriosis
- No personal or family history of cancer; no recent viral illnesses; no bone pain
- Current medications: no chronic medications; acetaminophen as needed; multivitamin
- Laboratory findings:
- CBC reveals platelets 21 X 109/L
- All other findings with normal range
- Negative forH pylori, HIV, and HCV
- Diagnosis: chronic ITP
- Started course of prednisone 1 mg/kg X 21 days, then tapered off; at evaluation, platelets: 27 X 109/L
- Second course of prednisone 1 mg/kg X 21 days; at evaluation, platelets still <30
- Third course of prednisone 1 mg/kg X 21 days; at evaluation, platelets still <30
February 2018
- “Rash” partly resolved, bruising still present
- Patient complains of weight gain on treatment and trouble sleeping
- After discussion with patient, she is started on eltrombopag (PROMACTA), at a dose of 50 mg/day
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