Use of Romiplostim during pregnancy as a rescue therapy in primary immune thrombocytopenia: Literature review and case description

Thrombocytopenia could appear during pregnancy, in up to 8-10% of the cases, where 3-5% is related to an autoimmune process so-called immune thrombocytopenia (ITP). We present a 34-year-old woman debuted at 13 weeks gestation, with a platelet count of 19 x 10(9)/L and petechiae. She did not respond to initial treatment with corticosteroids and intravenous immunoglobulin. At this point, considering the limited treatment options due to toxicity and/or teratogenesis of other drugs proven to be effective against ITP like azathioprine, rituximab, cyclophosphamide, etc. and the risk of bleeding symptoms, either from mother or fetus, we decided to begin treatment with Romiplostim (thrombopoietin receptor agonist). On reviewing the literature at this matter, only eight cases with ITP were treated during pregnancy with Romiplostim and only one of those, the ITP, was refractory to Romiplostim. In a retrospective study, Romiplostim used as a bridge to surgery in 47 patients stated a platelet count increment higher than 100 x 10(9)/L in 79% cases after two doses of Romiplostim. According to bibliography, we decided to start Romiplostim to our patient at 35 weeks of gestation with a spectacular platelet count recovery of 158 x 10(9)/L within 1 week of treatment, at 36th week, and after induced labor, she had on the very next day an eutocic vaginal childbearing without major bleeding complications.