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[Therapy-refractory thrombocytopenia in chronic hepatitis C]
U Mey1, R Kleinschmidt, T Sauerbruch
1Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität Bonn.
Zeitschrift Fur Gastroenterologie
|June 30, 2000
Summary
Hepatitis C infection can cause severe thrombocytopenia. Cyclophosphamide effectively treated a patient with refractory autoimmune thrombocytopenia, offering a new therapeutic option for chronic hepatitis C patients.
Area of Science:
- Hepatology
- Hematology
- Immunology
Background:
- Chronic hepatitis C infection is associated with various extrahepatic manifestations.
- Autoimmune phenomena, including immune thrombocytopenia, can occur in patients with hepatitis C.
- Severe thrombocytopenia poses a significant bleeding risk.
Observation:
- A 74-year-old male with chronic hepatitis C presented with severe thrombocytopenia (3 G/l) and intestinal hemorrhage.
- Initial treatments with immunoglobulins, prednisone, and Danazol were ineffective.
- Bone marrow examination revealed increased megakaryocytes, consistent with immune thrombocytopenia.
Findings:
- The patient was diagnosed with hepatitis C-associated idiopathic thrombocytopenic purpura.
- A single dose of cyclophosphamide (2,000 mg) resulted in a sustained increase in platelet count to 100 G/l over 18 months.
- Cyclophosphamide demonstrated efficacy in a refractory case where other treatments failed.
Implications:
- Hepatitis C-associated autoimmune thrombocytopenia should be considered in patients with chronic hepatitis C and severe thrombocytopenia.
- Cyclophosphamide represents a viable and successful treatment option for refractory cases.
- This approach is particularly relevant when splenectomy is contraindicated or unlikely to be effective.