Romiplostim in chronic liver disease with severe thrombocytopenia undergoing an elective invasive procedure.

Thrombocytopenia is a common complication seen in patients with chronic liver disease, precluding or interfering invasive diagnostic and therapeutic procedures. Etiology is multifactorial, including hypersplenism, bone marrow suppression by HCV and a possible reduction in the level or activity of the hematopoietic growth factor thrombopoietin (TPO)(1). In addition to thrombocytopenia, functional platelet defects has been suggested. Romiplostim (Nplate, Amgen Inc, Thousands Oaks, Calif) is a new thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura who have had an insufficient response to corticosteroids, immunoglobulin or splenectomy (2). It has been not tested in chronic liver disease until now. Another thrombopoietin receptor agonist, eltrombopag (3), has been tested in chronic liver disease undergoing an elective invasive procedure. Although results were satisfactory in terms of platetelet count and avoidance of platelet transfusions, the trial was early stopped due to the observed incidence of portal vein thrombosis in the study group (4). We report a case of a Jehovah’s Witness that could successfully managed with romiplostim use. Case report