What are the International Consensus Report recommendations for the treatment of immune thrombocytopenia (ITP) during pregnancy?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Recommendations for the treatment of ITP during pregnancy include the following [40] :

  • A platelet count of 20 to 30 × 10 9/L in a nonbleeding patient is safe for most of pregnancy. A platelet count ≥50 × 10 9/L is preferred for delivery.
  • Initial treatment is with oral steroids or IVIG.
  • In Rh(D)-positive nonsplenectomized women, IV anti-D appears to be well tolerated and effective; however, it may potentially cause maternal or fetal hemolysis.
  • IVIG can provide a rapid, but often very transient, increase in platelet count and can be used to urgently increase platelet counts during bleeding or for delivery.
  • Combining therapies (prednisone with IVIg and/or IV anti-D) may elicit a response in patients refractory to single agents alone (Grade C recommendation). High-dose methylprednisolone, in combination with IVIg and/or azathioprine, is suggested for patients refractory to oral corticosteroids or IVIg alone (Grade C recommendation).
  • Rituximab can be considered in pregnancy for very severe cases, but perinatal and neonatal immunosuppression and subsequent infection are potential complications and require monitoring.
  • TPO-RAs may be considered in late pregnancy when other treatments have failed, but published information is limited.
  • In the rare instances when splenectomy is required, it should be performed in the second trimester.
  • Vinca alkaloids, danazol, and immunosuppressive drugs not listed in these recommendations should be avoided in pregnancy.

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