The first‐line treatment for pediatric immune thrombocytopenia (ITP) consists of observation, i.v. immunoglobulin (IVIG), or corticosteroids. Although these procedures resolve the condition in most affected children, some are refractory to treatment or relapse. Recent second‐line treatments, such as cyclosporin, rituximab or thrombopoietin receptor (TPO‐R) agonist are promising, but some patients do not respond well to them. Splenectomy remains the only salvage intervention that may induce a curative effect in nearly two‐thirds of such patients. We report a case of refractory ITP. The patient did not respond to first‐ and second‐line treatment. Concomitant use of eltrombopag and IVIG resulted in transient increase of platelet count and allowed a safer execution of splenectomy that resulted in remission of ITP. This is the first successful treatment of pediatric refractory ITP using TPO‐R agonist and IVIG.A 4‐year‐old girl saw the family physician with ecchymoses on the extremities and nasal bleeding. On laboratory analysis, platelets were 3 × 109/L, and platelet‐associated IgG concentration was 140 ng/107 cells. She was admitted to a local hospital and was diagnosed with primary ITP. IVIG with oral prednisolone therapy increased the platelet count temporarily to 50 × 109/L, but it decreased to 1 × 109/L within 1 week
Pediatrics International – Wiley
Published: Jan 1, 2018
Keywords: ; ; ; ;
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