Management of immune-mediated cytopenias in pregnancy

Immune-mediated cytopenias are a well-described complication of pregnancy. Appropriate recognition and treatment are important in order to limit maternal and fetal morbidity and mortality. First line treatment options are fairly well-established for these entities. Refractory disease may be difficult to manage because treatment choices are limited by known or unestablished risk to the fetus. While the use of new agents, such as romiplostim and rituximab, has been reported, their safety in pregnancy is not known. This article summarizes immune cytopenias seen in pregnant patients, and it also discusses management of these cytopenias, and provides practical strategies for the treatment of these challenging conditions.