Case study:
Nicole
*
35-year-old female
with ITP
with ITP

Age: | 35 |
Occupation: | Unemployed |
Date of Diagnosis: | June 20, 2018 |
Comorbidities: |
|
MEDICAL HISTORY: |
|
PATIENT REFERRED TO HEMATOLOGY/ONCOLOGY SPECIALIST BY PRIMARY CARE PHYSICIAN SUSPECTING ITP DUE TO SEVERE BRUISING ON EXTREMITIES
Nicole’s treatment history
June 20, 2018: Patient referred to hematology/oncology specialist (hem-onc) by primary care physician suspecting ITP due to severe bruising on extremities
PLATELET COUNT: 4 x 109/L
CLINICAL OBSERVATIONS: Severe bruising on arms and legs
LABORATORY FINDINGS: Normal
PATIENT DISCUSSION:
- Nicole shared that she has a history of intravenous (IV) drug use and that she hasn’t used drugs in 3 years; she would like to avoid injections or infusions for this reason
- Nicole recalls experiencing transient thrombocytopenia during pregnancy (2015)
HEM-ONC TREATMENT PLAN:
- Initiate prednisone 60 mg QD; Nicole’s low platelet count and symptoms require treatment to rapidly increase platelet counts

Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
6/20/18 | 4 x 109/L | Severe bruising on extremities | Normal | Low platelet count; primary care physician suspected ITP and referred Nicole to hem‑onc | Nicole diagnosed with ITP |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
6/21/18 | 10 x 109/L | Severe bruising on extremities | Normal | Platelet count is still low | Initiate prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
7/30/18 | 25 x 109/L | Minimal bruising remains | Normal | Slight increase in platelet count | Administered IVIG; continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
8/7/18 | 81 x 109/L | Negative for bleeding/bruising | Normal | Substantial increase in platelet count; monitor durability of response | Continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
8/24/18 | 15 x 109/L | Negative for bleeding/bruising | Normal | Transient response to IVIG; administer IVIG again and monitor | Administered IVIG; continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
9/3/18 | 71 x 109/L | Negative for bleeding/bruising | Normal | Platelet count increase due to IVIG; monitor durability of response | Continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
9/17/18 | 35 x 109/L | Negative for bleeding/bruising | Normal | Transient response to IVIG; administer IVIG again and monitor | Administered IVIG; continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
10/10/18 | 62 x 109/L | Negative for bleeding/bruising | Normal | Nicole’s platelet count has increased but responses to IVIG are transient | Continue prednisone 60 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
11/6/18 | 55 x 109/L | Negative for bleeding/bruising | Normal | Slight decrease in platelet count; current treatment regimen has not stabilized platelet count, warranting an exploration of alternate therapeutic approaches | Continue prednisone 60 mg QD |
ALT=alanine aminotransferase; AST=aspartate aminotransferase; BP=blood pressure; IVIG=IV immunoglobulin; LFT=liver function test.
After Nicole experienced transient responses to IVIG while on prednisone, her hem-onc sought an oral medication in a different class of therapy.
The intent of this case study is to present the experience of a single patient, which may not represent the outcomes in the overall patient population. Response to treatment may vary from patient to patient.
NICOLE'S TREATMENT WITH TAVALISSE
December 5, 2018: TAVALISSE initiation
BASELINE PLATELET COUNT: | 52 x 109/L |
CLINICAL OBSERVATIONS: |
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LABORATORY FINDINGS: |
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PATIENT DISCUSSION: |
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TREATMENT PLAN: |
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Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
12/5/18 | 52 x 109/L | Slightly elevated BP; negative for bleeding/bruising | AST: 21 IU/L ALT: 18 IU/L |
Nicole is pleased to start an oral medication that may reduce need for IVIG | Initiate TAVALISSE 100 mg BID; begin 3-week prednisone taper |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
12/18/18 | Unknown | BP: 125/79; negative for bleeding/bruising | Bilirubin: 0.6 mg/dL |
Nicole to continue prednisone taper, titrating down from 20 mg to 10 mg | Continue TAVALISSE 100 mg BID; continue prednisone taper |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
12/24/18 | Unknown | Negative for bleeding/bruising | Normal | Prednisone taper complete | Prednisone discontinued; continue TAVALISSE 100 mg BID |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
1/5/19 | 132 x 109/L | BP: 119/82; negative for bleeding/bruising | AST: 22 IU/L ALT: 25 IU/L |
Significant increase in platelet count | Continue TAVALISSE 100 mg BID |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
1/15/19 | 175 x 109/L | Negative for bleeding/bruising | AST: 19 IU/L ALT: 18 IU/L |
Nicole reports moderate diarrhea, but claims she’s been able to control it with loperamide | Continue TAVALISSE 100 mg BID; continue loperamide for diarrhea management |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
2/4/19 | 200 x 109/L | BP: 121/72; negative for bleeding/bruising | Normal | Nicole reports that diarrhea recurred despite loperamide use | TAVALISSE dose decreased to 100 mg QD; continue loperamide for diarrhea management |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
2/20/19 | 150 x 109/L | Negative for bleeding/bruising | AST: 23 IU/L ALT: 19 IU/L |
Nicole reports that urgency and frequency of diarrhea have persisted and are impacting daily life; discussed withholding TAVALISSE until diarrhea is under control | Withhold TAVALISSE for 2 weeks, then resume at 100 mg QD; discontinue loperamide upon cessation of diarrhea |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
3/5/19 | 58 x 109/L | Negative for bleeding/bruising | Normal | Decrease in platelet count; no reports of diarrhea | Reinitiate TAVALISSE 100 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
3/25/19 | 76 x 109/L | Negative for bleeding/bruising | Bilirubin: 0.7 mg/dL |
Platelet count steadily increasing; no reports of diarrhea | Continue TAVALISSE 100 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
6/21/19 | 240 x 109/L | BP: 118/77; negative for bleeding/bruising | AST: 19 IU/L ALT: 25 IU/L |
Increase in platelet count; no reports of diarrhea | Continue TAVALISSE 100 mg QD |
Date | Platelet count | Clinical Observations | Laboratory Findings | Physician Notes | Treatment Plan |
---|---|---|---|---|---|
8/19/19 | 151 x 109/L | BP: 120/80; negative for bleeding/bruising | Normal | No further reports of diarrhea; LFTs and BP have remained within normal range throughout treatment; Nicole is pleased that her platelet counts have stabilized and she hasn’t experienced any bruising or bleeding | Maintain TAVALISSE 100 mg QD dose and monitor labs monthly |
Nicole responded well to TAVALISSE—her platelet count stabilized above 150 x 109/L on the 100 mg QD dose and she hasn’t experienced any bleeding.
*This case study contains data from an actual TAVALISSE patient. Patient name and image have been changed to protect privacy. This case study is intended for general medical education purposes only and is not a substitute for independent clinical medical judgment. The intent of this case study is to present the experience of a single patient, which may not represent the outcomes in the overall patient population. Response to treatment may vary from patient to patient.