How to treat chronic ITP in a 29-year-old?

Question

Hi doctor,

My sister is 29 and has been diagnosed with chronic immune thrombocytopenia for about three years now. Her platelet count often fluctuates, and the recent test shows platelets at 47,000, hemoglobin 11.2, and WBC 6,400. She has been taking Eltrombopag on and off, but lately, she has been complaining of severe fatigue, bruises on her arms, and gum bleeding. She is also planning to conceive next year and is scared that her condition could affect pregnancy or lead to any complications during childbirth. Is pregnancy even safe in her case, and should she plan it only after her platelet count stabilizes? Are there safer treatment options during pregnancy that would not harm the baby?

Also, her periods have become irregular and heavy lately, wants to know if that could be linked to CITP or the medication side effects? We are unsure if she should continue Eltrombopag or switch to another medicine before family planning. What precautions should we take before trying for conception?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am deeply concerned about your worries. Immune thrombocytopenia (ITP) occurs when your immune system destroys your own platelets. Many women with chronic ITP can have successful pregnancies, but it does require close coordination between your hematologist and obstetrician (preferably a high-risk or maternal-fetal medicine specialist).

Risks of pregnancy with ITP:

1. Bleeding risk: With platelets around more than 30,000 to 50,000, most women are safe from spontaneous bleeding, though bruising and gum bleeding may occur. The main risk is excessive bleeding during delivery or postpartum, particularly if platelets fall below 50,000. Epidural anesthesia is generally avoided if platelets are less than 80,000 due to spinal bleeding risk.

2. Miscarriage: ITP itself does not cause miscarriage.

3. For the baby: Maternal antibodies can cross the placenta and cause neonatal thrombocytopenia in about 10 to 15 % of babies, but severe bleeding in the newborn is rare (less than 1 %).

Throughout pregnancy, more than 30,000 platelets prevent spontaneous bleeding. At the time of delivery, more than 50,000 platelets are safe for vaginal and cesarean delivery. If an epidural is planned, platelets should be more than 80,000. Avoid spinal hematoma.

Management:

Take tablet Folic acid 5 mg and continue vitamin D3 till the end of pregnancy.
You should consult a hematologist and gynecologist.
Start tablet Prednisolone 20 mg, increase up to 60 mg.

I hope this information will help you.

Thanks.