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
Ashley Marshall, MSN, CNM
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