Corina POPOVICI, Andrada PARVU, Roxana SHURGER-CIMPONERIU, Anca Simona BOJAN
Abstract
Background: Immune thrombocytopenic purpura (ITP), a rare autoimmune disorder, is characterized by platelet destruction alongside inadequate bone marrow production, resulting in low platelet counts. While ITP is primarily associated with bleeding risks, it paradoxically increases the risk of thrombotic events, as all those with enough clinical experience can confirm. This case series explores the complexities of managing both thrombosis and hemorrhage in ITP patients.
Objective: To highlight the challenges of successfully managing thrombosis and hemorrhage in ITP patients undergoing treatment, focusing on two distinct cases that exemplify this clinical dilemma.
Methods: We present two cases: one of cerebral venous sinus thrombosis in a young patient on thrombopoietin receptor agonists (TPO-RAs) and another involving concurrent bleeding and pulmonary embolism in an elderly diabetic patient. Both cases were managed with individualized treatment approaches, balancing treating the thrombotic episode while managing the hemorrhagic risk.
Results: In the first case, discontinuation of TPO-RA and corticosteroid treatment resolved thrombosis, while in the second case, anticoagulation and TPO-RA therapy controlled both bleeding and thrombosis. Both patients responded well, with no recurrence of thrombosis after adjustment of their treatment regimens.
Conclusion: ITP presents a dual risk of bleeding and thrombosis, necessitating careful treatment strategies. Physicians must weigh the benefits of TPO-RA therapy against its thrombotic risks, especially in high-risk patients. Individualized treatment, including anticoagulation when appropriate, is critical in managing these complex cases.
https://doi.org/10.59854/dhrrh.2024.2.3.143
