Indirect hyperbilirubinemia because of eltrombopag in two cases after autologous hematopoetic stem cell transplantation.

The oral thrombopoietin receptor agonist eltrombopag has some side effects. One of them is related to bilirubin metabolism. Two patients with neuroblastoma in remission underwent stem cell transplantation with the Busulfan-melphalan regimen. Eltrombopag was started because of platelet engraftment failure. Indirect hyperbilirubinemia was detected after eltrombopag treatment. Laboratory and radiological investigations were all normal. The drugs and their side effects they used were examined. After eltombopag cutting, bilirubin levels of them returned to normal. These cases are presented to emphasize that eltrombopag can cause liver toxicity with hypertransaminesemia and hyperbilirubinemia. Drug side effects should be considered in the differential diagnosis of the patients. The significance of this case is that testing for serum aminotransferase and bilirubin levels should be monitored before and after eltrombopag use.