Acute renal thrombotic microangiopathy caused by eltrombopag and romiplostim in a patient with myelodysplastic syndromes (MDS) and underlying antiphospholipid syndrome
  • Nikhil Sood
    Department of Internal Medicine, Banner Gateway and Banner MD Anderson Cancer Center, Banner Health, Gilbert, USA
  • Margarita Kushnir
    Department of Hematology, Banner Gateway and Banner MD Anderson Cancer Center, Banner Health, Gilbert, USA
  • Bindu Jayavelu
    Southwest Kidney Institute, Tempe, USA


Acute renal failure, acute thrombotic microangiopathy, antiphospholipid syndrome


Romiplostim and eltrombopag are synthetic agonists of the thrombopoietin receptor (TPO-R), commonly used for immune thrombocytopenic purpura (ITP) and sometimes in myelodysplastic syndrome (MDS). They are rarely associated with kidney injury. We report a case of acute kidney injury caused by romiplostim and eltrombopag in an 80-year-old male patient with MDS and ITP. He did not have systemic haemolysis syndrome but isolated acute renal thrombotic microangiopathy confirmed by kidney biopsy. He was treated with steroids, plasmapheresis and anticoagulation, with improvement in renal function. Interestingly, the patient had high antiphospholipid (aPL) antibodies noted upon screening, indicating a possible new antiphospholipid syndrome (APS) diagnosis. In the presence of circulating aPL antibodies, eltrombopag may have served as a trigger, causing endothelial injury and subsequent renal microangiopathy; aPL antibodies were still significantly positive at four weeks of outpatient testing. This case and a few others reported in the literature highlight the importance of screening for aPL antibodies before initiating TPO-R agonists in patients with ITP. We suspect that using TPO-R agonists, rather than underlying aPL, caused renal failure.



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    Published: 2024-05-31
    Issue: 2024: Vol 11 No 7 (view)

    How to cite:
    Sood N, Kushnir M, Jayavelu B. Acute renal thrombotic microangiopathy caused by eltrombopag and romiplostim in a patient with myelodysplastic syndromes (MDS) and underlying antiphospholipid syndrome. EJCRIM 2024;11 doi:10.12890/2024_004564.