Abstract
Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder, defined by a platelet count of less than 100 × 109/L, secondary to impaired production and immune destruction of platelets. Bleeding tendency is the main presentation of this condition. Clinical symptoms and investigations will confirm the diagnosis. Steroid is the first line of treatment. Although Rituximab and Thrombopoietin receptor agonists are useful second line agents in non-pregnant adults, the data about their role in pregnancy are still limited. We present the case of a 30 year old primigravida, who was a known case of chronic ITP since childhood; the course of her disease was fluctuating, for which oral steroids were used accordingly. She presented with gum bleeding and petechial rash with very low platelets count. She was sponsored by the Patient Support Program and was given Eltrombopag during the third trimester. She responded well to Eltrombopag with no noticeable side effects, neither to the mother nor to the baby so far. Eltrombopag has been assigned Category C by the Federal Drugs Agency (FDA) nevertheless there are no well controlled data in the literature about its role in pregnancy.
Highlights
We present the case of a 30 year old primigravida, who was a known case of chronic Immune thrombocytopenic purpura (ITP) since childhood; the course of her disease was fluctuating, for which oral steroids were used
We present a case of severe ITP who was successfully treated with Eltrombopag in pregnancy
CD4-positive helper cells in reaction to platelet surface glycoproteins which possibly involves CD40/CD40L co stimulation produce antibodies leading to the autoimmune destruction. These antibody coated platelets are destroyed by the tissue macrophages located in the spleen leading to their reduced life span. Both humoral and cellular immunity targeted at megakaryocytes, in addition to the autoreactive cytotoxic T cells leads to reduced platelet production [2]
Summary
ITP should be considered in pregnancy when the platelet counts fall below 100,000/ul. It can be differentiated from Gestational thrombocytopenia, which is a close differential diagnosis, as the platelet counts usually don’t fall below 100,000 in the latter. Severe ITP should be considered when the platelet count falls below 50,000/ul with bleeding symptoms requiring immediate therapy. Immune thrombocytopenia (ITP) occurs in approximately 1 to 3 in 1000 pregnancies [4]; approximately ten-fold higher compared to the general population. The approach to treatment of ITP in pregnancy depends on whether the patient is actively bleeding and the gestational age. We present a case of severe ITP who was successfully treated with Eltrombopag in pregnancy
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