The Fellow on Call: The Heme/Onc Podcast
Jul 1, 2026 · 29 min · 11 segments
This week, we put everything we talked about in our ITP series together and talk about how we manage ITP in complicated patient scenarios. Through a case-based discussion, we discuss how to we would…
So let's say you have a 24-year-old otherwise healthy female patient who is diagnosed with ITP.
Her baseline platelet count remains consistently in the 80s.
She recently became pregnant and is in her first trimester.
What do you do now? So this is pregnancy ITP, and now we have a pregnant patient who's in her first trimester.
So thrombocytopenia and pregnancy in itself could be a whole episode, but a quick note is that the most common cause of thrombocytopenia in the first trimester is ITP.
In the second trimester, it's the most common cause for patients with a platelet count of less than 100, and in the third trimester, there's a lot of other causes.
There's a really nice image that we'll include in our show notes from the ASH How I Treat guidelines that really lays this out, but it's important as we make our differential diagnosis, especially since ITP is a diagnosis of exclusion.
So Raunak, I wa- I wanna recap that because that's, that's so important, echo what you just said.
First trimester, it's probably ITP.
Second trimester, if you're less than 100, probably ITP.
Third trimester, think of all the other stuff.
Yeah.
You said it, you said it well, Vivek.
So the guidelines typically recommend close observation and not treating in the first eight months of pregnancy unless the platelet count is less than 20 or there is bleeding.
In the weeks leading up to the expected due date, all of this changes.
It varies by institution, but in general, it's important that patients maintain platelet counts over than greater than 70 in order to get an epidural, especially in preparation for the delivery.
And if no epidural is desired, most of OBs will want platelets over 50 just to help with the complications of bleeding.
So let's say treatment is needed.
There's different treatment options here in terms of dosages.
You can do 0.4 grams per kilogram for five days, or you can do one gram per kilogram for two days, or you can even give two grams per kilogram once.
And this can be considered every few weeks to really maintain that platelet count in that safe range that you need for your patient.
If steroids are needed, remember that prednisone is preferred over dexamethasone, and that's 'cause dexamethasone can cross the placenta and cause fetal birth defects.
Steroids are typically, though, reserved for patients until the 35th or 36 week mark just to try to limit the maternal side effects.
So let's say you have a 24-year-old otherwise healthy female patient who is diagnosed with ITP.
Her baseline platelet count remains consistently in the 80s.
She recently became pregnant and is in her first trimester.
What do you do now? So this is pregnancy ITP, and now we have a pregnant patient who's in her first trimester.
So thrombocytopenia and pregnancy in itself could be a whole episode, but a quick note is that the most common cause of thrombocytopenia in the first trimester is ITP.
In the second trimester, it's the most common cause for patients with a platelet count of less than 100, and in the third trimester, there's a lot of other causes.
There's a really nice image that we'll include in our show notes from the ASH How I Treat guidelines that really lays this out, but it's important as we make our differential diagnosis, especially since ITP is a diagnosis of exclusion.
So Raunak, I wa- I wanna recap that because that's, that's so important, echo what you just said.
First trimester, it's probably ITP.
Second trimester, if you're less than 100, probably ITP.
Third trimester, think of all the other stuff.
Yeah.
You said it, you said it well, Vivek.
So the guidelines typically recommend close observation and not treating in the first eight months of pregnancy unless the platelet count is less than 20 or there is bleeding.
In the weeks leading up to the expected due date, all of this changes.
It varies by institution, but in general, it's important that patients maintain platelet counts over than greater than 70 in order to get an epidural, especially in preparation for the delivery.
And if no epidural is desired, most of OBs will want platelets over 50 just to help with the complications of bleeding.
So let's say treatment is needed.
There's different treatment options here in terms of dosages.
You can do 0.4 grams per kilogram for five days, or you can do one gram per kilogram for two days, or you can even give two grams per kilogram once.
And this can be considered every few weeks to really maintain that platelet count in that safe range that you need for your patient.
If steroids are needed, remember that prednisone is preferred over dexamethasone, and that's 'cause dexamethasone can cross the placenta and cause fetal birth defects.
Steroids are typically, though, reserved for patients until the 35th or 36 week mark just to try to limit the maternal side effects.
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