What are the ASH recommendation for 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

Treatment considerations include the following:

  •  Women with no bleeding manifestations and platelet counts ≥30×10 9/L do not require any treatment until 36 weeks’ gestation (sooner if delivery is imminent).
  •  If platelet counts are < 30×10 9/L or clinically relevant bleeding is present, first-line therapy is oral corticosteroids or intravenous immunoglobulin (IVIG).
  • The recommended starting dose of IVIG is 1 g/kg.
  • Prednisone and prednisolone are preferred to dexamethasone, which crosses the placenta more readily.
  • Recommended starting doses of prednisone by different experts vary from 0.25 to 0.5 to 1 mg/kg daily; no evidence exists that a higher starting dose is better.
  • Medications should be adjusted to maintain a safe platelet count.

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