A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

Kong, Zhangyuan; Qin, Ping; Xiao, Shan; Zhou, Hai; Li, Hong; Yang, Renchi; Liu, Xiaofan; Luo, Jianmin; Li, Zhichun; Ji, Guochao; Cui, Zhongguang; Bai, Yusheng; Wu, Yuxia; Shao, Liming; Peng, Jun; Ma, Jun; Hou, Ming

doi:10.1182/blood-2017-01-761262

Cited by 91 publications

(108 citation statements)

References 48 publications

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“…93 A recent report of the use of a recombinant human thrombopoietin in 60 pregnancies is promising. 94 The optimal platelet count at delivery has not been established. A platelet count of 75 to 80 3 10 9 /L in the absence of other hemostatic abnormalities is generally recommended by most guidelines.…”

Section: Itp In Pregnancymentioning

confidence: 99%

Clinical updates in adult immune thrombocytopenia

Lambert

Gernsheimer

2017

Blood

361

319

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Immune thrombocytopenia (ITP) occurs in 2 to 4/100 000 adults and results in variable bleeding symptoms and thrombocytopenia. In the last decade, changes in our understanding of the pathophysiology of the disorder have led to the publication of new guidelines for the diagnosis and management of ITP and standards for terminology. Current evidence supports alternatives to splenectomy for second-line management of patients with persistently low platelet counts and bleeding. Long-term follow-up data suggest both efficacy and safety, in particular, for the thrombopoietin receptor agonists and the occurrence of late remissions. Follow-up of patients who have undergone splenectomy for ITP reveals significant potential risks that should be discussed with patients and may influence clinician and patient choice of second-line therapy. Novel therapeutics are in development to address ongoing treatment gaps.

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Section: Itp In Pregnancymentioning

confidence: 99%

Clinical updates in adult immune thrombocytopenia

Lambert

Gernsheimer

2017

Blood

361

319

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“…19 There is little evidence on which to base treatment of women refractory to a combination of corticosteroids and IVIG. Human recombinant thrombopoietin (not currently available in the United States) has been used with success in 1 pilot study, 20 and there are anecdotal reports involving the use of thrombopoietin receptor agonists such as romiplostim in the weeks prior to delivery. 21,22 It is difficult to define the risk to the fetus of individual immunosuppressive agents due to the lack of disease-specific and disease-severity controls.…”

Section: Immune Thrombocytopeniamentioning

confidence: 99%

Thrombocytopenia in pregnancy

Cines¹,

Levine

2017

Blood

134

137

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Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances made over the past 5 to 10 years in understanding and managing the more common causes of thrombocytopenia in pregnancy. Recent trends in the management of immune thrombocytopenia translate into more women contemplating pregnancy while on treatment with thrombopoietin receptor agonists, rituximab, or mycophenylate, which pose known or unknown risks to the fetus. New criteria to diagnose preeclampsia, judicious reliance on measurement of ADAMTS13 to make management decisions in suspected thrombotic thrombocytopenic purpura, new evidence supporting the efficacy and safety of anticomplement therapy for atypical hemolytic uremic syndrome during pregnancy, and implications of thrombotic microangiopathies for subsequent pregnancies are evolving rapidly. The goals of the chapter are to help the hematology consultant work through the differential diagnosis of thrombocytopenia in pregnancy based on trimester of presentation, severity of thrombocytopenia, and coincident clinical and laboratory manifestations, and to provide guidance for dealing with some of the more common and difficult diagnostic and management decisions.

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“…While romiplostim and eltrombopag are not recommended or even contraindicated in pregnant women, TPIAO seems to be effective and safe in these patients [105]. Table 14.…”

Section: Tpiaomentioning

confidence: 99%