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Have ITP and on the NPlate. Skipped some dosage. Need of bypass surgery?

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Practicing since : 2002
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My Dad has ITP and has been on the NPlate for 4 months. The doctor has skipped doses and doubled doses - even when he was in the acceptable range of 50-200 WWW.WWWW.WW He now has to have double bypass surgery - platelet counts were at 60 today and the doc increased his dosage (drup protocal says to maintain). The doctor also stated he should have rituxan AND nplate before Dad's bypass surgery. Do they ususally give these together?
Mon, 11 Feb 2013 in Hypertension and Heart Disease
Answered by Dr. Robert Galamaga 7 minutes later
Hello and thank you for sending your question.

Your question is a very good one and I will work on providing you with some information and recommendations.

Your father is currently in a very unusual situation. In the setting of ITP along with A need for surgery an adequate platelet count is certainly a priority.

Generally if the platelet count is close to 100 the likelihood of excessive bleeding is lower.

It is not common but it is certainly reasonable to use Rituxan along with Nplate. This will tend to increase the platelet count by decreasing the activity of the immune system.

There are newer drugs such as Promacta which might be considered as well. I would ask his hematologist about that as well.

Thank you again for sending your question. Please let me know if you have any additional concerns regarding this matter.

Dr. Robert
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