ITP in pregnancy: diagnostics and therapeutics in 2024

Thrombocytopenia will occur in 10% of pregnancies—ranging from the clinically benign to processes that can threaten both mother and fetus. Accurately identifying the specific etiology and appropriate clinical management is challenging due to the breadth of possible diagnoses and the potential of shared features among them. Further complicating diagnostic certainty is the lack of confirmatory testing for most possible pathophysiologies. Immune thrombocytopenia (ITP) is recognized in less than 0.1% of pregnancies but is the most common cause of thrombocytopenia in early trimesters. ITP is an autoimmune disease of IgG-mediated enhanced platelet clearance and reduced platelet production. While there is an increasing number of drugs approved to treat ITP and more being examined in clinical trials, few have been sufficiently studied in pregnancy, representing a major unmet need in clinical practice. As such, treatment options for ITP in pregnancy are limited to corticosteroids and immunoglobulin therapy, which will not be effective in all cases. Maternal ITP also may have fetal impact, and any proposed therapeutic intervention must account for this possibility. Optimal care requires multidisciplinary collaboration between hematology, obstetrics, and anesthesia to enhance diagnostic clarity, develop an optimized treatment regimen, and shepherd mother and neonate to delivery safely.