case_images: PMC7136763_01
case_images: Patient's platelet counts relative to the time courses of his treatment before (a) and after (b) hospitalization. In (a) and (b), the Y-axis and the X-axis represent platelet counts and the number of days before and after the first treatment of evolocumab, respectively. Day 0 indicates the initial day of evolocumab therapy. The periods of atorvastatin and evolocumab treatment are indicated above the graph in (a). PT, platelet transfusions (two injections); HI, high-dose immunoglobulin (25 g per day for 5 consecutive days); E, eltrombopag (thin line, 12.5 mg; thick line, 25 mg per day, respectively); P, prednisone (starting with 1 mg/kg).
case_images: CRIHEM2020-3281626.001.jpg
case_images: PMC7136763_01_CRIHEM2020-3281626.001.jpg
case_images: fig1
case_images: On the 13th and just prior to the 14th treatment with evolocumab, his platelet count was 211,000 and 210,000/muL, respectively; however, it suddenly decreased to 1,000/muL on day 12 following his 14th treatment with evolocumab (Figure 1(a)), and he presented with symptoms of acute severe thrombocytopenia. The patient started a combination of steroid therapy, high-dose immunoglobulin therapy, and platelet transfusions (Figure 1(b)). Three months later, his platelet count had returned to normal and remained at approximately 200,000/muL during the 2-month follow-up period post-initiation of eltrombopag (Figure 1(b)).