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Case Reports in Hematology
Volume 2013, Article ID 391086, 5 pages
http://dx.doi.org/10.1155/2013/391086
Case Report

Refractory Thrombocytopenia Responds to Octreotide Treatment in a Case of Evans Syndrome with Gastric Neuroendocrine Tumor

1Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 33, Peru
2Hematology Department, Hospital Nacional “Edgardo Rebagliati Martins”, Lima 33, Peru
3Clinical Pathology Department, Hospital Nacional “Edgardo Rebagliati Martins”, Lima 33, Peru

Received 20 May 2013; Accepted 8 July 2013

Academic Editors: S. Aref, C. Imai, and T. Sonoki

Copyright © 2013 Kocfa Chung-Delgado et al. 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

A 37-year-old woman with history of Evans Syndrome with poor response to high-dose corticoid treatment presented to the emergency department with gastrointestinal and vaginal bleeding. The patient was later diagnosed with severe thrombocytopenia and a stage G1, well-differentiated gastric neuroendocrine tumor, confirmed by a biopsy. A total gastrectomy was performed to eradicate the tumor. After being treated with a total splenectomy for her Evans Syndrome with no clinical or laboratory improvement, she began regular treatment with octreotide on the basis of a possible hepatic metastasis. Days after the initiation of the octreotide, an increase in the platelet count was evidenced by laboratory findings, from 2,000 platelets/mm3 to 109,000 platelets/mm3. Weeks later, the hepatic metastasis is discarded by a negative octreotide-body scan, and the octreotide treatment was interrupted. Immediately after the drug interruption, a progressive and evident descent in the platelet count was evidenced (4000 platelets/mm3). The present case report highlights the possible association between octreotide treatment and a severe thrombocytopenia resistant to conventional treatment.