Abstract:
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Dear Editor, Thrombocytopenia is a common complication seen in patients
with chronic liver disease, precluding or interfering invasive diagnostic
and therapeutic procedures. Etiology is multifactorial,
including hypersplenism, bone marrow suppression by HCV and
a possible reduction in the level or activity of the hematopoietic
growth factor thrombopoietin (TPO)(1). In addition to thrombocytopenia,
functional platelet defects has been suggested. Romiplostim
(Nplate®, Amgen Inc, Thousands Oaks, Calif) is a new
thrombopoietin receptor agonist indicated for the treatment of
thrombocytopenia in patients with chronic immune thrombocytopenic
purpura who have had an insufficient response to corticosteroids,
immunoglobulin or splenectomy (2). It has been not
tested in chronic liver disease until now. Another thrombopoietin
receptor agonist, eltrombopag (3), has been tested in chronic liver
disease undergoing an elective invasive procedure. Although
results were satisfactory in terms of platetelet count and avoidance
of platelet transfusions, the trial was early stopped due to the
observed incidence of portal vein thrombosis in the study group
(4). We report a case of a Jehovah’s Witness that could successfully
managed with romiplostim use... |