NYMC Faculty Publications

Eltrombopag Use for Refractory Immune Thrombocytopenia in Pregnancy: A Case Report

Author Type(s)

Faculty

Journal Title

Case Reports in Women's Health

First Page

00281

Last Page

00281

Document Type

Case Report

Publication Date

1-2021

Department

Pediatrics

Second Department

Obstetrics and Gynecology

Abstract

BACKGROUND: Immune thrombocytopenic purpura (ITP) is a rare autoimmune disorder that involves platelet destruction in the spleen. Eltrombopag (Promacta®), a thrombopoietin agonist, has been used in non-pregnant patients to manage ITP, but few cases of its use in pregnancy have been reported.

CASE PRESENTATION: We present a case of a pregnant patient at 26 weeks of gestation with severe refractory ITP. After first-line therapies failed, the patient was treated with the drug eltrombopag. The patient had no response to initial therapy, and the fetus developed supraventricular tachycardia (SVT). This resolved with maternal digoxin but the patient elected to stop the eltrombopag. The patient refused further experimental and second-line treatments, and after a multidisciplinary meeting a decision was made to deliver by cesarean section at 30 weeks of gestation due to severe refractory ITP and allow other therapies to be tried postpartum. Preeclampsia and neonatal atrial flutter were encountered in the postpartum period but both mother and baby had good outcomes.

CONCLUSION: Refractory ITP in pregnancy is not well studied. Eltrombobag could have maternal and fetal side-effects but a multidisciplinary approach to management leads to favorable maternal and fetal outcomes.

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