{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:24:24Z","timestamp":1765232664264,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,12,3]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>A 61-year-old woman with chronic lymphocytic leukaemia, with Richter\u2019s transformation to a diffuse, large, B-cell lymphoma, treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and in complete remission, presented to the hospital after her platelets were found to be 2\u00d710\u00b3\/\u00b5L in outpatient laboratory studies. She initially underwent a platelet transfusion without improvement. This was followed by 4\u2009days of high-dose dexamethasone and intravenous immunoglobulin, which again yielded no meaningful effect. Even a single-dose rituximab failed to achieve a platelet increase after 5\u2009days of monitoring. The patient was then given 2\u2009mg of intravenous vincristine along with a high-dose of dexamethasone and IVIG and demonstrated substantial recovery in platelets to &gt;50\u00d710\u00b3\/\u00b5L within 48\u2009hours. This case study provides an overview of the current management strategies for idiopathic thrombocytopenic purpura that is unresponsive to conventional medical therapy and particularly sheds light on their therapeutic benefits and potential adverse effects.<\/jats:p>","DOI":"10.1136\/bcr-2018-227717","type":"journal-article","created":{"date-parts":[[2019,1,14]],"date-time":"2019-01-14T12:55:43Z","timestamp":1547470543000},"page":"bcr-2018-227717","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Rescue therapy for acute idiopathic thrombocytopenic purpura unresponsive to conventional treatment"],"prefix":"10.1136","volume":"12","author":[{"given":"Samuel Benjamin","family":"Reynolds","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phuong","family":"Ngo","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goetz","family":"Kloecker","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,14]]},"reference":[{"key":"2025082708541499000_12.1.bcr-2018-227717.1","first-page":"35","article-title":"Clinical review \u2013 immune thrombocytopenia","volume":"12","author":"DeLoughery","year":"2017","journal-title":"Hospital Physician; Hematology-Oncology Board Review Manual"},{"key":"2025082708541499000_12.1.bcr-2018-227717.2","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1056\/NEJMoa030254","article-title":"Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone","volume":"349","author":"Cheng","year":"2003","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082708541499000_12.1.bcr-2018-227717.3","first-page":"756","article-title":"Clinical practice updates in the management of immune thrombocytopenia","volume":"42","author":"Khan","year":"2017","journal-title":"P T"},{"key":"2025082708541499000_12.1.bcr-2018-227717.4","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.ijsu.2014.10.012","article-title":"Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria","volume":"12","author":"Rijcken","year":"2014","journal-title":"Int J Surg"},{"key":"2025082708541499000_12.1.bcr-2018-227717.5","first-page":"1","article-title":"Sustained remission in patients with primary immune thrombocytopenia after romiplostim tapering and discontinuation: a case series in real life management in Spain","volume":"2017","author":"Mingot-Castellano","year":"2017","journal-title":"Case Rep Hematol"},{"key":"2025082708541499000_12.1.bcr-2018-227717.6","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1097\/MBC.0000000000000726","article-title":"Treatment characteristics, efficacy and safety of thrombopoietin analogues in routine management of primary immune thrombocytopenia","volume":"29","author":"Mingot-Castellano","year":"2018","journal-title":"Blood Coagulation & Fibrinolysis"},{"key":"2025082708541499000_12.1.bcr-2018-227717.7","doi-asserted-by":"crossref","first-page":"3526","DOI":"10.1182\/blood-2007-01-065763","article-title":"Multiagent induction and maintenance therapy for patients with refractory immune thrombocytopenic purpura (ITP)","volume":"110","author":"Boruchov","year":"2017","journal-title":"Blood"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-227717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:54:25Z","timestamp":1756310065000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-227717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,14]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bcr-2018-227717"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-227717","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}