Severe immune thrombocytopenia in pregnancy treated with Eltrombopag - A case report

Immune thrombocytopenia (ITP) during pregnancy is an acquired autoimmune disease present in 1-2 of every 1000 pregnancies. Thrombopoietin (TPO)-mimetic drugs, such as eltrombopag, have been successfully used for treatment of ITP during pregnancy, but studies regarding its safety during gestation are lacking. A 33-year-old nulliparous woman with a history of chronic ITP, presented at the emergency department with petechiae, epistaxis, bruises, conjunctival effusions and a platelet count of 3×10⁹/L at 25 weeks gestation. Her pregnancy had been uneventful until then. She was unresponsive to a therapeutic escalade of corticosteroids, azathioprine and intravenous immunoglobulin (IV Ig) so, at 27 weeks, eltrombopag was initiated, and analytical and clinical improvement was achieved. Labor was induced at 37 weeks due to preeclampsia, culminating in a vacuum-assisted vaginal delivery. A healthy female newborn weighing 2400g was born. After delivery, both had normal platelet counts and remained clinically stable through follow-up.