ITP induced by pregnancy

Hoping someone has a similar story and can relate.........
I had a child in 2013 a baby boy. I was on 3 months maternity leave, after having a physical to return to work, they found that my platelet count was 98,000. I was referred to a rheumatologist and a hematologist. I went to the rheumatologist first, had multiple blood test done for lupus and other things. There was no significant finding. 3 months pregnant with my 2nd child my platelet count was 163,000 (Normal). so forward to may of 2015, one month before my daughter was born. My count was 32,000. Forward to June 28th, 2015 my daughter decided to make her grande entrance 1 day before her due date. During prep for delivery, they found my platelet count to be 18,000 which meant no epidural. Once the baby was delivered, they checked her platelets and they were 8,000. In things I have read online. There is about a 2% chance this happens to the mother and the baby. My daughter was admitted to the Nicu that night. She had 4 platelet transfusions, 3 Iv Igg she did not show much improvement and then was placed on steroids. A pediatric hematologist came to the nicu to see her and and allowed her to go home after 11 days with her counts in the 20,000 and to follow up with her weekly. She was showing improvement and her counts dropped again. she was admitted back to the hospital where she received two nights of Iv Igg dose as well as the steroids which improved her counts to approx 185,000. She was released from the hospital and monitored by her Dr. We were told it can take at least 3 month for the antibody that was passed to her to clear from system. She will be 3 months in a week.

So now onto me. I thought that all of this is due to pregnancy and that my counts would go back to normal post baby. I started to bruise and found out my platelet did not improve on there own. They kept dropping. So finally when they were 7,000 I went to a hematologist the very next day. I was instantly placed on steroids. 80mg ( according to the pharmacist and very high dose). Plus the side effects are very depressing. With not much improvement I was moved to Rituxan. I receive my 4th dose on thursday and I'm currently being weaned off of the steroid. Well my counts are not any better. As of last Thursday my platelets are 15,000. With much concern of this procedure not working (the chemo) they are already talking about promacta. I'm worried about the side effects and the long term use and effects. What are the chances this will fix with treatment and not have to live on medicine. Or the worst case a spleenectomy. Are there any similar stories or studies with out comes. I am a firefighter paramedic an the thought of not being able to return to full duty is heartbreaking. I'm hoping someone has some answers or has had patients go through the same thing.

Lizzy:

ITP can possibly rear it's head during pregnancy due to hormonal changes. Women acquire autoimmune disorders more than men do, so it is suspected that hormones play a big part in it. It can take months to get back to normal after a pregnancy, so there is still a chance that your counts could recover with or without treatment.

Rituxan can take 4 to 12 weeks to work, so I wouldn't give up on that yet. Rituxan isn't chemo, it is a Biologic drug like Enbrel and Humira. N-Plate generally works with few side effects, and some people do go into remission after using it for a few months or years. It is way too early to worry about being on meds for life or having a splenectomy. ITP requires patience, and most get it under control in time.

As for your job, you'd need to ask your doctor where he would like your count so that you can safely return to work. He should be able to adjust the N-Plate dose to try and hit that target count. It could take a while to get stabilized, but there is every reason to hope that you will get there.

Keep us posted and good luck!

Thank You Sandi!
I'm hoping pregnancy is all it is. Is N-plate Rituxan??? Also I am learning to have patients it has been 3 months and hoping it gets under control soon. But if it takes longer what choice do I have. Thank you Sandi. I see you respond to alot of things and are very knowledgeable in the subject. I will keep you posted in my progress.

Liz

Nplate is not Rituxan. Sandi seems to have got confused and said Nplate when she meant Promacta. The two are similar acting drugs which is why she thought of one when you mentioned the other.

Yes, sorry, I meant Promacta. I do get confused sometimes!

Hi Lizzy. Thirteen years ago I was diagnosed with ITP when pregnant with my second child. After she was born (antibodies did not transfer), my counts eventually increased back into a more normal range. My hematologist decided the ITP was pregnancy induced. For many years my platelet account remained over 100. Last year I ended up in the ER with a platelet count of 3. In the past 11 months I've tried prednisone (100 mg), Rituxan and neither of them worked for me. I was able to stay safe with IVIG treatments. I'm now trying Promacta, with mixed success so far (counts between 199 and 15).

I can't imagine how stressful it must be for you right now. Hang in there!

Im hoping all it is is pregnancy. I cant imagine it happening in the future everything Im going through right now. I get follow up blood work on the 8th which is 2 weeks post Rituxan 4th treatment. Hoping for good news.