ASH 2025 | The management of patients with ET or PV during pregnancy

So this is a very specialized area and I think these patients need to be managed carefully in a centre with expertise in myeloproliferative neoplasms. I would suggest that actually the first bit is that any patient intending to become pregnant should have pre-pregnancy planning before that, looking at their risk group, their blood counts and seeing how the best management of that is. But obviously not all pregnancies are planned, so in that case they should be referred.
All patients, I don’t think you need to distinguish between ET and PV, are then managed, depending on their blood counts, whether they need cytoreduction or not, but with low-dose aspirin. So low-dose aspirin, and then if they need cytoreduction, this would be interferon in somebody that is pregnant. The patient should be assessed very carefully and should be managed by a joint team of hematologists and obstetricians. And we place a lot of emphasis on monitoring the blood flow to the placenta because the problem with these pregnancies is increased fetal loss because of placental blood flow problems. So they should have this managed with doctors early in pregnancy and again later on ensuring that there’s a good functioning placenta. If there are problems then there may be questions about introducing cytoreductive therapy. The other thing I should say also is that polycythaemia vera needs to have their haematocrit reduced less than 0.45 and actually you can make an argument in pregnancy for taking it lower depending on how far they are through the pregnancy.
Delivery then also needs to be carefully planned with the patient and also the obstetrician and the hematologist as to whether they need their treatment changed in any way, need their blood counts changed, whether the anaesthetist is happy to, for instance, do an epidural or whether they need their aspirin reduced prior to that. After delivery, where there’s an increased thrombotic risk, we often suggest that these patients may need to be anticoagulated or at least aspirin continued for six weeks. And there are clear guidelines that have been published on this, the management of pregnancy by experts and I would suggest that these patients need to be managed with people with particular expertise in myeloproliferative and also the obstetricians who they’re sort of a high-risk pregnancy, so they need to be managed carefully.

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