# When Platelets Fail: A Case of Active Gastrointestinal Bleeding in Immune Thrombocytopenia

## TL;DR

This case report details a 77-year-old woman with immune thrombocytopenia who experienced severe gastrointestinal bleeding and required multiple treatments for platelet recovery.

## Contribution

The case highlights the challenges in managing ITP with severe bleeding and the effectiveness of romiplostim in achieving sustained platelet recovery.

## Key findings

- Initial treatment with corticosteroids and IVIG failed to resolve persistent thrombocytopenia.
- Romiplostim administration led to sustained platelet recovery in the patient.
- Infectious and medication-related triggers were identified as potential contributors to ITP onset.

## Abstract

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by the destruction of platelets due to autoantibodies, leading to an increased risk of bleeding. This case report describes a 77-year-old female who presented with acute gastrointestinal bleeding, severe thrombocytopenia, and mucocutaneous purpura. Initial laboratory evaluation revealed a critically low platelet count of <5 ×10³/μL, prompting urgent management with platelet transfusions, intravenous corticosteroids, and intravenous immunoglobulin (IVIG). Despite initial treatment, her thrombocytopenia persisted, necessitating the administration of the thrombopoietin receptor agonist romiplostim, which led to sustained platelet recovery. Further investigations revealed a recent history of an upper respiratory infection treated with antibiotics and newly diagnosed hepatitis C, highlighting potential infectious and medication-related triggers. This case underscores the complexity of ITP diagnosis and management, emphasizing the need for individualized treatment strategies, particularly in cases of severe bleeding. It also reinforces the importance of early recognition and timely intervention to prevent life-threatening complications.