Can someone with chronic ITP have a safe pregnancy?

Question

Hello doctor,

I was diagnosed with chronic immune thrombocytopenia five years ago, and my platelet count has been unstable, ranging from 15,000 to 80,000. I am currently on Prednisone 20 mg daily, but the side effects are severe, including weight gain, mood swings, and bone density loss. My hematologist tried Rituximab infusions last year, but they only worked temporarily.

My platelets dropped to 22,000 last month, and I had severe menstrual bleeding that required an emergency room visit. The gynecologist wants to discuss endometrial ablation, but hematology is concerned about the bleeding risk. I am 38 years old, and I want to have another child, but the thrombocytopenia makes pregnancy high risk.

What are newer treatment options for chronic immune thrombocytopenia that might be safer for fertility?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I understand how challenging this must be, managing chronic immune thrombocytopenia (ITP) while balancing fertility goals.

Newer ITP treatments and fertility considerations:

TPO-RAs (thrombopoietin receptor agonists) – Eltrombopag (Promacta, Revolade) and Romiplostim (Nplate): First-line alternatives. They stimulate platelet production without immunosuppression. Must stop before pregnancy (limited pregnancy data), but can help achieve stability before conception.
Syk inhibitor (spleen tyrosine kinase inhibitor) – Fostamatinib (Tavalisse, Tavlesse): Reduces platelet destruction. Also paused pre-pregnancy.
Potential curative options: Discuss splenectomy (if feasible) or FcRn (neonatal Fc receptor) inhibitors (e.g., Efgartigimod – newly approved for ITP), which may offer sustained responses.

For menorrhagia, I suggest:

Immediate: Tranexamic acid (antifibrinolytic) during menses; progesterone (intrauterine device - IUD, or pills) to reduce bleeding.
Ablation: Avoid if future pregnancy is desired, as it often causes infertility.

I hope this helps.

Kindly follow up if you have more doubts.