Introduction
Eltrombopag is small-molecule nonpeptide Thrombopoietin Receptor (TPO-R)
agonist administered orally. It was approved for treatment of
thrombocytopenia to increase platelets count and protect patients from
bleeding. It’s usually very well tolerated orally and has excellent
safety profile with an overall response rate of 60% to 80% [1].
Eltrombopag response is followed by frequent platelets count
measurements and subsequently manipulated to achieve adequate platelets
count to avoid both thrombocytopenia and thrombocytosis. Eltrombopag can
be used as first or second line, alone or in combination with other
medications for ITP [2].
In clinical practice, the term ‘thrombocytosis’ refers to platelet
counts above 450,000/mm³ [3]. Thrombocytosis can be primary or
secondary to other causes because platelets are acute phase reactant.
The use of Eltrombopag will stimulate the bone marrow to produce
platelets and the dose will be adjusted accordingly. In clinical
practice, some patient who are already on Eltrombopag may developed
rapid platelets count increment due to reactive thrombocytosis. This
situation will be challenging to physicians in manipulating the dose of
the drug and whether withdrawal of Eltrombopag will be safe and will not
expose the patient to risk of bleeding especially patients who are
stable on fixed dose for long time.
In this case report, we share our experience in adjusting the dose of
Eltrombopag during secondary reactive thrombocytosis.