Successful resection of intrahepatic cholangiocarcinoma with idiopathic thrombocytopenic purpura using thrombopoietin receptor agonist: a case report

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 × 10 4 /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 × 10 4 /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.