Successful management of refractory immune‐mediated thrombotic thrombocytopenic purpura during pregnancy and delivery using the anti‐VWF nanobody caplacizumab

Abstract

SummaryPregnancy is a potential trigger of acute thrombotic thrombocytopenic purpura (TTP). The management of pregnancy‐associated immune‐mediated TTP (iTTP) can be challenging, especially when it is refractory to standard treatment. Caplacizumab, a nanobody to von Willebrand factor (VWF) blocking its A1 domain, is a valuable new therapeutic option. Its use is, however, not approved during pregnancy and breastfeeding. We describe the successful off‐label administration of caplacizumab during pregnancy and delivery in a patient with refractory iTTP. The favourable outcome without significant thrombotic or haemorrhagic complications indicates that caplacizumab may be an effective and safe treatment option in refractory iTTP during pregnancy.