PB0715 - Evolving Diagnoses in a Case of Chronic Thrombocytopenia: From Immune Thrombocytopenia to Systemic Lupus Erythematosus

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Liana G. Hambardzumyan, Master's degree

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia

Co-Author(s)

NM

Nata Melkikyan

Hematologist
Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
AM

Alisa Movsisyan

Hematologist
Yeolyan Hematology and Oncology Center
Yerevan, Yerevan, Armenia
CS

Clodet Stepanians

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
Nelli S. Sargsyan

Hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
LP

Lilit S. Petrosyan

hematologist
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan, Armenia
Yerevan, Yerevan, Armenia
VV

Valentina Vardanyan

Rheumatologist
Department of Rheumatology, Yerevan State Medical University, Yerevan, Armenia
Yerevan, Yerevan, Armenia
HG

Hayk Grigoryan

Hematologist
1. Yeolyan Hematology and Oncology Center, Yerevan Armenia
Yerevan, Yerevan, Armenia
Heghine S. Khachatryan, MD, PhD

Head of Hemophilia and Thrombosis Center
Hemophilia and Thrombosis Center, Yeolyan Hematology and Oncology Center, Yerevan Armenia YSMU, department of Hematology and Pediatric oncology
Yerevan, Yerevan, Armenia

Background: Patients with primary immune thrombocytopenia (ITP) have a greater risk of developing systemic lupus erythematosus (SLE) than the general population.

Aims: This abstract delineates the complex medical journey of a 46-year-old female patient, initially diagnosed with primary immune thrombocytopenia (ITP) in 1997.

Methods: During the diagnostic workup and follow-up SLE and antiphospholipid syndrome (APS) were excluded several times. Treatment modalities with Prednisone and Eltrombopag failed to elicit a sustained recovery as the disease course was complicated with multiple hospitalizations, and transfusions because of heavy uterine bleeding and epistaxis.

Results: In February 2022 patient was again admitted with epistaxis and heavy uterine bleeding. Complete blood count showed severe thrombocytopenia 3.0 x 109/L. Ultrasound revealed splenomegaly (17.0 x 6.0 cm) and hepatomegaly (19.0 x 8.0 cm). The patient received Methylprednisolone pulse therapy for 4 days (1000mg IV per day) without any improvement. In April 2022 injection of Human Immunoglobulin 50 g also failed to ameliorate the thrombocytopenia. The CBC results following these interventions demonstrated a persistent and refractory pattern. Two months later performed splenectomy also didn’t increase platelet level.
The disease course led to the reevaluation of the diagnosis. Trephine biopsy didn’t reveal any dysplastic changes in the bone marrow but there is a possibility of autoimmune myelofibrosis. Diagnosis of paroxysmal nocturnal hemoglobinuria was also excluded. In April 2023 repetition of antinuclear antibodies was positive, complement C3 and C4 fractions were decreased and diagnosis of SLE was confirmed by the rheumatologist.

Conclusion(s): This clinical case serves as a poignant illustration of the challenging nature of autoimmune disorders, particularly when met with refractory responses to conventional treatments. The journey from Immune Thrombocytopenia to Systemic Lupus Erythematosus underscores the importance of continuous monitoring, reevaluation of diagnostic paradigms, and adaptability in therapeutic strategies and dynamic approaches to patient care.