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Paritosh Garg: Management of ITP in Pregnancy – What Changed My Practice?

Paritosh Garg/LinkedIn

Jun 19, 2026, 16:24

Paritosh Garg: Management of ITP in Pregnancy – What Changed My Practice?

Paritosh Garg, Associate Consultant at Fortis Memorial Research Institute, India, shared a post on LinkedIn:

“Management of ITP in Pregnancy: What Changed My Practice?

Thrombocytopenia affects up to 10% of pregnancies, but true immune thrombocytopenia (ITP) remains an uncommon yet clinically important challenge. Distinguishing ITP from gestational thrombocytopenia, preeclampsia, and thrombotic microangiopathies is often more difficult than treating it.

A few practical take-home messages from the recent ASH review:

ITP is the most likely cause of thrombocytopenia presenting in the 1st or early 2nd trimester.
Treatment is usually not required during most of pregnancy unless there is significant bleeding or platelet count falls below 20 × 10⁹/L.
Target platelet count for delivery: ≥50 × 10⁹/L.
If neuraxial anesthesia is planned, aim for ≥70 × 10⁹/L.
Prednisone and IVIG remain the cornerstone therapies, despite the expanding ITP treatment landscape.
Evidence for TPO receptor agonists in pregnancy is growing, but their use should currently be reserved for highly selected refractory cases.
Management works best when hematology, obstetrics, and anesthesia function as a single team.

Perhaps the most important reminder: in pregnancy, the goal is not a normal platelet count—it is a platelet count that safely supports both mother and baby through delivery.”

Paritosh Garg: Management of ITP in Pregnancy - What Changed My Practice?