CBC Monitoring After Romiplostim Injection
Check CBC weekly until platelet counts stabilize, then monthly thereafter. 1
Initial Dose Adjustment Phase
During the dose adjustment phase of romiplostim therapy, obtain complete blood counts (CBCs), including platelet counts, weekly until a stable dose is established. 1 This weekly monitoring is critical because:
- Platelet responses to romiplostim typically occur within 1-2 weeks of initiating treatment, with a median time to response of approximately 2 weeks 2
- The dose must be adjusted by 1 mcg/kg increments based on platelet count responses to achieve and maintain counts ≥50 × 10⁹/L 1
- Most patients who respond achieve target platelet counts within the first few weeks of treatment 3
Maintenance Phase Monitoring
Once a stable romiplostim dose is established, obtain CBCs including platelet counts monthly. 1 This reduced frequency is appropriate because:
- Median platelet counts of 50-200 × 10⁹/L are maintained with stable doses throughout long-term treatment 4
- Patients maintain platelet responses on a median 92% of study visits once stabilized 4
After Discontinuation
Following discontinuation of romiplostim, obtain CBCs including platelet counts weekly for at least 2 weeks. 1 This monitoring is essential due to:
- The potential risk of rebound thrombocytopenia after discontinuation 5
- The need to detect any rapid decline in platelet counts that may require intervention
Common Pitfalls to Avoid
- Do not extend monitoring intervals during dose adjustments – weekly monitoring is mandatory until stability is achieved, as premature reduction in monitoring frequency may miss critical platelet count fluctuations requiring dose modification 1
- Do not skip post-discontinuation monitoring – the 2-week minimum monitoring period after stopping romiplostim is crucial for detecting rebound thrombocytopenia 1