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  • Thrombopoietin-receptor agonists

    I am currently 37 4/7 weeks pregnant with my 7th child, having experienced 6 previous normal SVDs with subsequent normal breastfeeding experiences. This pregnancy however, I have been dealing with refractory ITP with PTL levels unpredictably responsive to both 100mg prednisone QD as well as 1mg/kg IVIG x 2 days over the past few weeks. Both my hematology team as well as MFM team would like to see my PTL counts be above 30,000 before the del, however, given the lack of response thus far, that might not be realistic. The heme docs are now talking about using TPO-RAs, namely nplate, to give my PTLS a boost. I've expressed my concerns about the lack of data on their use in pregnancy and would mostly likely refuse their use in my case. I would consider using them postpartum should my ITP not go into remission, however, my concerns would shift at that point to their effect on breastfeeding. I am able to find very little data on TPO-RAs and lactation and was hoping you and your team would have some insight. Thanks so much in advance.

    Ashley Marshall, MSN, CNM

  • #2
    Hi, thanks for your post.

    You are correct that there are no human studies on Nplate in breastfeeding women. We do know that it is a high molecular weight compound that has poor oral absorption. Both of these traits increase its breastfeeding safety. Large molecules penetrate the breastmilk poorly and the low oral absorption means that is less likely to end up in the baby's circulation. We give Nplate (romiplostim) an L3 (out of 5) ("probably compatible") mostly due to the lack of direct, empirical studies.

    Please call us at the InfantRisk Center if this has not completely answered your question or your physician is considering a different drug . (806)352-2519

    -James Abbey, MD
    and
    -Thomas W. Hale, Ph.D.

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