Massive intrasplenic arterial thrombosis in a patient with chronic ITP during the development of an Evans syndrome

Thromb Res. 2021 Dec:208:226-229. doi: 10.1016/j.thromres.2021.02.021. Epub 2021 Feb 24.

Abstract

Long-term safety and efficacy of eltrombopag in adults with persitent/chronic primary immune thrombocytopenia (ITP) evaluated in EXTEND study, showed a high response rate (80%) but, in the clinical safety study, it was observed that 6% of the patients presented venous and arterial thrombotic events. In addition, in the course of the disease, autoimmune hemolytic anemia (Evans syndrome, ES) may occur and could increase the risk of thrombosis. We report an interesting case of splenic rupture due to massive intrasplenic arterial thrombosis in the course of ES in a patient with chronic ITP treated with eltrombopag. The purpose of this case report is to highlight the potential increase in thrombotic risk that may involve the use of eltrombopag in hemolysis situations in patients with ITP.

Keywords: Autoimmune haemolytic anemia; Eltrombopag; Evans syndrome; Immune thrombocytopenia; Thrombopoietin receptor agonist; Thrombosis.

Publication types

  • Case Reports
  • Editorial

MeSH terms

  • Adult
  • Anemia, Hemolytic, Autoimmune* / complications
  • Anemia, Hemolytic, Autoimmune* / drug therapy
  • Humans
  • Purpura, Thrombocytopenic, Idiopathic* / complications
  • Purpura, Thrombocytopenic, Idiopathic* / drug therapy
  • Thrombocytopenia* / complications
  • Thrombocytopenia* / drug therapy
  • Thrombosis* / drug therapy
  • Thrombosis* / etiology

Supplementary concepts

  • Evans Syndrome