Pregnancy
Anti-platelet autoantibodies in a pregnant woman with ITP will attack the patients own platelets and will also cross the placenta and react against fetal platelets. Therefore, ITP is a significant cause of fetal and neonatal immune thrombocytopenia. Approximately 10% of newborns affected by ITP will have platelet counts <50,000/uL and 1% to 2% will have a risk of intracerebral hemorrhage comparable to infants with neonatal alloimmune thrombocytopenia (NAIT).No lab test can reliably predict if neonatal thrombocytopenia will occur. The risk of neonatal thrombocytopenia is increased with:
Mothers with a history of splenectomy for ITP
Mothers who had a previous infant affected with ITP
Gestational (maternal) platelet count less than 100,000/uLIt is recommended that pregnant women with thrombocytopenia or a previous diagnosis of ITP should be tested for serum antiplatelet antibodies. A woman with symptomatic thrombocytopenia and an identifiable antiplatelet antibody should be started on therapy for their ITP which may include steroids or IVIG. Fetal blood analysis to determine the platelet count is not generally performed as ITP-induced thrombocytopenia in the fetus is generally less severe than NAIT. Platelet transfusions may be performed in newborns, depending on the degree of thrombocytopenia. It is recommended that neonates be followed with serial platelet counts for the first few days after birth. History
After initial reports by the Portuguese physician Amato Lusitano in 1556 and Lazarus de la Rivière (physician to the King of France) in 1658, it was the German physician and poet Paul Gottlieb Werlhof who in 1735 wrote the most complete initial report of the purpura of ITP.
Cenegermin, sold under the brand name Oxervate, also known as recombinant human nerve growth factor (rhNGF), is a recombinant form of human nerve growth factor (NGF). In July 2017, it was approved in the European Union as an eye drop formulation for the treatment of moderate or severe neurotrophic keratitis in adults.As a recombinant form of NGF, cenegermin is a peripherally selective agonist of the TrkA and LNGFR (p75NTR) which must be administered parenterally.The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication. History
It was developed by Anabasis Pharma, Dompé Farmaceutici, and Ospedale San Raffaele. Research
In addition to neurotrophic keratitis, cenegermin is also under development for the treatment of dry eyes, retinitis pigmentosa, and glaucoma. References
Further reading
Sheha H, Tighe S, Hashem O, Hayashida Y (October 2019). "Update On Cenegermin Eye Drops In The Treatment Of Neurotrophic Keratitis". Clin Ophthalmol. 13: 1973–1980. doi:10.2147/OPTH.S185184. PMC 6789413. PMID 31631965. External links
"Cenegermin". Drug Information Portal. U.S. National Library of Medicine.