How to manage chronic ITP in women trying to conceive?

Question

Hi doctor,

I am 33 years old and was recently diagnosed with chronic immune thrombocytopenic purpura after experiencing unexplained bruising and heavy menstrual bleeding. My platelet count remains low despite treatment with steroids, and I am concerned about the long-term effects, particularly because I am planning to become pregnant next year. Are there safer treatment options available for women who are trying to conceive? My menstrual periods have been extremely heavy and exhausting. Could this be related to the low platelet count? I also feel very anxious about undergoing any type of surgery or dental procedure. Could you please explain what chronic immune thrombocytopenic purpura means in simple terms and what steps I should take now to protect my health and prepare for pregnancy?

Please help me.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am sorry that you are facing this uncertainty; it is a lot to handle. Let us break it down clearly:

Chronic immune thrombocytopenic purpura means that your immune system mistakenly attacks your platelets, which are the cells responsible for blood clotting. This leads to symptoms such as bruising and heavy menstrual bleeding.

Regarding pregnancy planning, safer treatment options are as follows:

Thrombopoietin receptor agonists (such as Romiplostim or Eltrombopag) are often the first choice. They help increase platelet counts without affecting fertility.
Intravenous immunoglobulin is considered safe for a quick rise in platelet levels before conception or medical procedures.
Rituximab should be avoided for at least one year before attempting pregnancy.

Your heavy menstrual bleeding is very likely related to immune thrombocytopenic purpura, as low platelet counts impair blood clotting. Tranexamic acid can help reduce bleeding, but only if platelet levels are above 50,000 platelets per microlitre of blood.

Recommended next steps are as follows:

Consult a hematologist who has experience managing immune thrombocytopenic purpura during pregnancy.
Arrange for preconception counseling involving both an obstetrician and a hematologist.
Avoid non-steroidal anti-inflammatory drugs; use Acetaminophen for pain relief instead.
For dental procedures: if your platelet count is below 50,000 platelets per microlitre of blood, pre-treatment with intravenous immunoglobulin or steroids may be necessary.

You are not alone in this. We will work together to create a plan that prioritizes your safety.

I hope this answer helps you.

Thank you.