LAUSR

A nine-year-old, intact male, mixed-breed dog was admitted with a three-day history of severe thrombocytopenia and bleeding diathesis. Physical examination revealed mucosal and cutaneous petechiae and ecchymoses, melena and gross hematuria. Clinicopathologic evaluation indicated severe thrombocytopenia, anemia and panhypoproteinemia. Serology for common endemic vector-borne pathogens was negative and thoracic and abdominal imaging was unremarkable. Bone marrow aspiration cytology revealed aplasia of the megakaryocytic lineage, in the context of a mildly hypoplastic myeloid and a normal erythroid series. A diagnosis of presumptive primary amegakaryocytic immune thrombocytopenia (ITP) was established. Treatment with vincristine, prednisolone, and mycophenolate mofetil along with several whole blood transfusions failed to achieve clinical and clinicopathologic remission. As an adjunct treatment, romiplostim was administered at a cumulative dose of 15 μg/kg, subcutaneously, in two sessions, one week apart, and complete clinical and hematological remission was noted 8 days post-initiation of romiplostim. Thirty-eight months later, the dog remains clinically healthy with no evidence of hematological relapse. Romiplostim could be a promising adjunctive treatment option in dogs with refractory ITP.