International Journal of Hematology

, Volume 108, Issue 1, pp 109–111 | Cite as

A low birth weight infant with no malformations delivered by a primary immune thrombocytopenia patient treated with eltrombopag

  • Naruko Suzuki
  • Junji Hiraga
  • Yumi Hariyama
  • Yusuke Takagi
  • Haruhiko Ohashi
  • Yasuyuki Kishigami
  • Hidenori Oguchi
  • Yoshitoyo Kagami
Case Report


Primary immune thrombocytopenia (ITP) is defined by a low platelet count secondary to antibody-mediated platelet destruction or reductions in platelet production. Although eltrombopag is a thrombopoietin receptor agonist that increases platelet production in refractory or relapsed ITP, the influence on pregnancy is limited. We present the case of a pregnant 25-year-old ITP patient referred to our hospital with a history of two induced abortions. After eradication of Helicobacter pylori and with oral prednisolone at 8 mg/day, platelet count remained below 10,000/µl. Because she declined splenectomy, eltrombopag was initiated at 12.5 mg/day. Afterward, platelet count was maintained at over 50,000/µl. Twenty-one months later, pregnancy became apparent. She continued treatment, and cesarean section was performed at 37 weeks of gestation after administration of intravenous immunoglobulin, platelet transfusions, and steroids. The baby weighed only 1670 g but showed no malformations, and platelet count at birth was 416,000/µl. Studies of eltrombopag in pregnancy have not been reported. A case with administration of eltrombopag from the last trimester of pregnancy that resulted in low birth weight has been reported. Embryo lethality and reduced fetal weights have been reported from animal experiments. Further investigation about the relationship between low birth weight deliveries and eltrombopag is necessary.


Primary immune thrombocytopenia (ITP) Eltrombopag Pregnancy 


Compliance with ethical standards

Conflict of interest

All the authors declare no conflict of interest.


  1. 1.
    Gernsheimer T, Stratton J, Ballem PJ, Slichter SJ. Mechanisms of response to treatment in autoimmune thrombocytopenic purpura. N Engl J Med. 1989;320:974–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Chang M, Nakagawa PA, Williams SA, Schwartz MR, Imfeld KL, Buzby JS, et al. Immune thrombocytopenic purpura (ITP) plasma and purified ITP monoclonal autoantibodies inhibit megakaryocytopoiesis in vitro. Blood. 2003;102:887–95.CrossRefPubMedGoogle Scholar
  3. 3.
    McMillan R, Nugent D. The effect of antiplatelet autoantibodies on megakaryocytopoiesis. Int J Hematol. 2005;81:94–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Fujimura K, Miyakawa Y, Kurata Y, Kuwana M, Tomiyama Y, Murata M. Reference guide for management of adult idiopathic thrombocytopenic purpura (ITP) 2012 version. Rinsho Ketsueki. 2012;53:433–42.PubMedGoogle Scholar
  5. 5.
    Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117:4190–207.CrossRefPubMedGoogle Scholar
  6. 6.
    Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168–86.CrossRefPubMedGoogle Scholar
  7. 7.
    Miyakawa Y. Consensus report on the management of immune thrombocytopenia in pregnancy. Rinsho Ketsueki. 2015;56:2086–91.PubMedGoogle Scholar
  8. 8.
    Bussel JB, Cheng G, Saleh MN, Psaila B, Kovaleva L, Meddeb B, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenia purpura. N Engl J Med. 2007;357:2237–47.CrossRefPubMedGoogle Scholar
  9. 9.
    González-López TJ, Fernández-Fuertes F, Hernández-Rivas JA, Sánchez-González B, Martínez-Robles V, Alvarez-Román MT, et al. Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice. Int J Hematol. 2017;106:508–16.CrossRefPubMedGoogle Scholar
  10. 10.
    Purushothaman J, Puthumana KJ, Kumar A, Innah SJ, Gilvaz S. A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag. Asian J Transfus Sci. 2016;10:155–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Patil AS, Dotters-Katz SK, Metjian AD, James AH, Swamy GK. Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy. Obstet Gynecol. 2013;122:483–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wyszynski DF, Carman WJ, Cantor AB, Graham JM Jr, Kunz LH, Slavotinek AM, et al. Pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura. J Pregnancy. 2016;2016:8297407.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  1. 1.Department of HematologyToyota Kosei HospitalToyotaJapan
  2. 2.Department of Obstetrics and GynecologyToyota Kosei HospitalToyotaJapan
  3. 3.Department of HematologyToyota Memorial HospitalToyotaJapan
  4. 4.Department of Obstetrics, Perinatal Medical CenterToyota Memorial HospitalToyotaJapan

Personalised recommendations