A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag
Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successf...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2016-01-01
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| Series: | Asian Journal of Transfusion Science |
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| Online Access: | http://www.ajts.org/article.asp?issn=0973-6247;year=2016;volume=10;issue=2;spage=155;epage=158;aulast=Purushothaman |
| _version_ | 1811330789135089664 |
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| author | Jyothis Purushothaman Kochuthresia J Puthumana Aswath Kumar Susheela J Innah Sareena Gilvaz |
| author_facet | Jyothis Purushothaman Kochuthresia J Puthumana Aswath Kumar Susheela J Innah Sareena Gilvaz |
| author_sort | Jyothis Purushothaman |
| collection | DOAJ |
| description | Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions. After 2 weeks of hospital stay, the patient did not respond to treatment with steroid and immunosuppressant. There was a rapid decline in platelet count with mucosal bleeds for which she required frequent platelet transfusions. Due to high costs, short action periods, and other potential maternal and fetal side effects of intravenous immunoglobulin (IVIgG) and anti-D, it was decided that TPO-mimetic drug eltrombopag would be given. After starting treatment with eltrombopag, the patient's platelet count could be maintained between 30,000/μl and 50,000/μl. At 36 weeks of gestation following preterm-induced vaginal delivery, she delivered a male active baby weighing 1.86 kg with an Apgar score of 8/10. After delivery, her platelet count was 60,000/μl. Eltrombopag is a thrombopoietin receptor agonist. It has been assigned to pregnancy category C by the Food and Drug Administration (FDA). There are no adequate and well-controlled studies of use of eltrombopag in pregnancy. In our case, the drug was given in the last trimester of pregnancy and the mother and baby were in good health at the time of discharge from the hospital and during follow-up. |
| first_indexed | 2024-04-13T16:08:15Z |
| format | Article |
| id | doaj.art-9e102512871042019c5ceebb91acc066 |
| institution | Directory Open Access Journal |
| issn | 0973-6247 1998-3565 |
| language | English |
| last_indexed | 2024-04-13T16:08:15Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Asian Journal of Transfusion Science |
| spelling | doaj.art-9e102512871042019c5ceebb91acc0662022-12-22T02:40:20ZengWolters Kluwer Medknow PublicationsAsian Journal of Transfusion Science0973-62471998-35652016-01-0110215515810.4103/0973-6247.177204A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopagJyothis PurushothamanKochuthresia J PuthumanaAswath KumarSusheela J InnahSareena GilvazImmune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions. After 2 weeks of hospital stay, the patient did not respond to treatment with steroid and immunosuppressant. There was a rapid decline in platelet count with mucosal bleeds for which she required frequent platelet transfusions. Due to high costs, short action periods, and other potential maternal and fetal side effects of intravenous immunoglobulin (IVIgG) and anti-D, it was decided that TPO-mimetic drug eltrombopag would be given. After starting treatment with eltrombopag, the patient's platelet count could be maintained between 30,000/μl and 50,000/μl. At 36 weeks of gestation following preterm-induced vaginal delivery, she delivered a male active baby weighing 1.86 kg with an Apgar score of 8/10. After delivery, her platelet count was 60,000/μl. Eltrombopag is a thrombopoietin receptor agonist. It has been assigned to pregnancy category C by the Food and Drug Administration (FDA). There are no adequate and well-controlled studies of use of eltrombopag in pregnancy. In our case, the drug was given in the last trimester of pregnancy and the mother and baby were in good health at the time of discharge from the hospital and during follow-up.http://www.ajts.org/article.asp?issn=0973-6247;year=2016;volume=10;issue=2;spage=155;epage=158;aulast=PurushothamanEltrombopagimmune thrombocytopenic purpuraneonatal alloimmune thrombocytopenia (NAIT)platelet transfusion |
| spellingShingle | Jyothis Purushothaman Kochuthresia J Puthumana Aswath Kumar Susheela J Innah Sareena Gilvaz A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag Asian Journal of Transfusion Science Eltrombopag immune thrombocytopenic purpura neonatal alloimmune thrombocytopenia (NAIT) platelet transfusion |
| title | A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| title_full | A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| title_fullStr | A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| title_full_unstemmed | A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| title_short | A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| title_sort | case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag |
| topic | Eltrombopag immune thrombocytopenic purpura neonatal alloimmune thrombocytopenia (NAIT) platelet transfusion |
| url | http://www.ajts.org/article.asp?issn=0973-6247;year=2016;volume=10;issue=2;spage=155;epage=158;aulast=Purushothaman |
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