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.