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Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report.
Surg Case Rep. 2019 Apr 10; 5(1):56.SC

Abstract

BACKGROUND

Patients with idiopathic thrombocytopenic purpura (ITP) have low platelet counts and an increased risk of complications. Therefore, these patients generally require high-dose immunoglobulin therapy and platelet transfusion. However, thrombopoietin receptor agonists (TPO-RAs) have recently become available for use in the preoperative treatment strategy for intractable ITP. Recent studies have also reported radiofrequency ablation (RFA) or tissue biopsy as perioperative management for thrombocytopenia using TPO-RA. However, no report has described the use of TPO-RA in a case of hepatectomy.

CASE PRESENTATION

A 76-year-old man presented with intrahepatic cholangiocarcinoma (IHCC) complicated with ITP. His platelet count was 3.5 × 104/μL. To increase platelet levels prior to surgery, romiplostim was administered subcutaneously (70 μg per week for 3 weeks) and eltrombopag was administered orally (25 mg per day for 23 days), as TPO-RA. His platelet count increased to 14.1 × 104/μL. The patient was successfully and safely treated with left hemi-hepatectomy and TPO-RA as preoperative platelet management.

CONCLUSIONS

This case suggests that TPO-RA can be effective, and could serve as a new treatment option in the preoperative management of ITP.

Authors+Show Affiliations

Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan. nharimotoh1@gunma-u.ac.jp.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30969381

Citation

Hoshino, Kouki, et al. "Successful Resection of Intrahepatic Cholangiocarcinoma With Idiopathic Thrombocytopenic Purpura Using Thrombopoietin Receptor Agonist: a Case Report." Surgical Case Reports, vol. 5, no. 1, 2019, p. 56.
Hoshino K, Harimoto N, Muranushi R, et al. Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report. Surg Case Rep. 2019;5(1):56.
Hoshino, K., Harimoto, N., Muranushi, R., Araki, K., Yamanaka, T., Hagiwara, K., Ishii, N., Tsukagoshi, M., Igarashi, T., Tanaka, H., Watanabe, A., Kubo, N., Yokobori, T., & Shirabe, K. (2019). Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report. Surgical Case Reports, 5(1), 56. https://doi.org/10.1186/s40792-019-0619-4
Hoshino K, et al. Successful Resection of Intrahepatic Cholangiocarcinoma With Idiopathic Thrombocytopenic Purpura Using Thrombopoietin Receptor Agonist: a Case Report. Surg Case Rep. 2019 Apr 10;5(1):56. PubMed PMID: 30969381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report. AU - Hoshino,Kouki, AU - Harimoto,Norifumi, AU - Muranushi,Ryo, AU - Araki,Kenichiro, AU - Yamanaka,Takahiro, AU - Hagiwara,Kei, AU - Ishii,Norihiro, AU - Tsukagoshi,Mariko, AU - Igarashi,Takamichi, AU - Tanaka,Hiroshi, AU - Watanabe,Akira, AU - Kubo,Norio, AU - Yokobori,Takehiko, AU - Shirabe,Ken, Y1 - 2019/04/10/ PY - 2019/01/08/received PY - 2019/04/02/accepted PY - 2019/4/11/entrez PY - 2019/4/11/pubmed PY - 2019/4/11/medline KW - Idiopathic thrombocytopenic purpura KW - Intrahepatic cholangiocarcinoma KW - Left hemi-hepatectomy KW - Thrombopoietin receptor agonist SP - 56 EP - 56 JF - Surgical case reports JO - Surg Case Rep VL - 5 IS - 1 N2 - BACKGROUND: Patients with idiopathic thrombocytopenic purpura (ITP) have low platelet counts and an increased risk of complications. Therefore, these patients generally require high-dose immunoglobulin therapy and platelet transfusion. However, thrombopoietin receptor agonists (TPO-RAs) have recently become available for use in the preoperative treatment strategy for intractable ITP. Recent studies have also reported radiofrequency ablation (RFA) or tissue biopsy as perioperative management for thrombocytopenia using TPO-RA. However, no report has described the use of TPO-RA in a case of hepatectomy. CASE PRESENTATION: A 76-year-old man presented with intrahepatic cholangiocarcinoma (IHCC) complicated with ITP. His platelet count was 3.5 × 104/μL. To increase platelet levels prior to surgery, romiplostim was administered subcutaneously (70 μg per week for 3 weeks) and eltrombopag was administered orally (25 mg per day for 23 days), as TPO-RA. His platelet count increased to 14.1 × 104/μL. The patient was successfully and safely treated with left hemi-hepatectomy and TPO-RA as preoperative platelet management. CONCLUSIONS: This case suggests that TPO-RA can be effective, and could serve as a new treatment option in the preoperative management of ITP. SN - 2198-7793 UR - https://www.unboundmedicine.com/medline/citation/30969381/Successful_resection_of_intrahepatic_cholangiocarcinoma_with_idiopathic_thrombocytopenic_purpura_using_thrombopoietin_receptor_agonist:_a_case_report_ DB - PRIME DP - Unbound Medicine ER -