Page 26 - Haematologica Vol. 107 - September 2022

REVIEW ARTICLE - ITP: diagnosis and second-line treatment J.B. Bussel and C.A. Garcia
What are the treatment considerations for our patient during pregnancy?
As ITP is common in women of reproductive age, it is not surprising that it may complicate the course of preg- nancy. For pregnant women with known ITP, management changes throughout the course of pregnancy.53 Figure 1 reviews treatment options available during each tri- mester, leading up to delivery and the post-partum period. In the first trimester of pregnancy, platelet counts may spontaneously increase, apparently because of the increased progestational hormones in the first tri- mester.54 For this reason, relatively few women with ITP require treatment in the first trimester, which is fortunate
from a teratogenic point of view. Risk of cleft palate from steroid use in the first trimester appears to be small.
In the second and especially third trimesters, platelet counts decrease even in healthy women without ITP, re- sulting in “gestational” thrombocytopenia.55 Three large series suggest that the prevalence of gestational throm- bocytopenia at the end of pregnancy is between 6.6% and 11.6%.56-60 This has been attributed to increased vol- ume of distribution in the later stages of pregnancy as well as “consumption”. Recently, work from China pres- ented at the 2021 European Hematology Association Con- gress hypothesized that very high estradiol levels towards the end of pregnancy inhibit platelet
Figure 1. Treatment options for immune thrombocytopenia during pregnancy, leading up to delivery, and in the post-partum period. IVIG: intravenous immunoglobulin; TPO-RA: thrombopoietin receptor agonist; ITP: immune thrombocytopenia.
Haematologica | 107 September 2022
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