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Case Reports in Hematology
Volume 2012 (2012), Article ID 318597, 4 pages
http://dx.doi.org/10.1155/2012/318597
Case Report

Myelofibrosis Associated with Romiplostim Treatment in a Patient with Immune Thrombocytopenia

Department of Pathology, Baystate Medical Center, Tufts University, 759 Chestnut Street, Springfield, MA 01199, USA

Received 8 December 2011; Accepted 17 January 2012

Academic Editors: S. Aref and K. Khair

Copyright © 2012 Maria Fernanda Gonzalez and Jonathan King Freeman. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Immune thrombocytopenia is characterized by antibody-mediated platelet destruction and insufficient platelet production resulting in isolated thrombocytopenia in the absence of underlying cause. Despite many treatment options, low-to-intermediate rates of remission and high rates of resistance to treatment are seen. Approximately 20% of patients do not attain a hemostatic platelet count after splenectomy or after first- and second-line medical approaches. A new option in these cases is treatment with romiplostim. Bone marrow (BM) fibrosis has been reported in clinical trials with romiplostim. We report a case with marked reticulin fibrosis of the BM, worsening of cytopenias and dyserythropoiesis, and atypical megakaryocytes, which did not reverse following cessation of the drug. Although this could represent idiopathic myelofibrosis, unrelated to therapy, the pretreatment biopsy demonstrating no fibrosis combined with the concordant timing of the drug and fibrosis suggests the treatment with romiplostim may be causative.