Erythropoietin therapy in a case of neonatal anemia after exposure to natalizumab throughout pregnancy

• Published in: Italian journal of pediatrics Vol. 47; no. 1; p. 69
• Main Authors: Godano, Elisabetta, Barra, Fabio, Allodi, Alessandra, Ferraiolo, Antonella, Laroni, Alice, Novi, Giovanni, Mancardi, Giovanni Luigi, Gustavino, Claudio, Arioni, Cesare
• Format: Journal Article
• Language: English
• Published: England BioMed Central 23.03.2021; BMC
• Subjects: Anemia; Babies; Baby foods; Blood; Breastfeeding & lactation; Case Report; Dosage; Drug dosages; Erythropoietin; Fetuses; Hematology; Hemoglobin; Monoclonal antibodies; Multiple sclerosis; Natalizumab; Neonates; Pancytopenia; Patients; Pediatrics; Physiology; Pregnancy; Severe acute respiratory syndrome coronavirus 2; Thrombocytopenia; Womens health; Pregnancy; Multiple sclerosis; Erythropoietin; Natalizumab; Anemia
• ISSN: 1824-7288; 1720-8424; 1824-7288
• DOI: 10.1186/s13052-021-01025-4

Natalizumab is a monoclonal antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis. According to the current clinical recommendations, its use during pregnancy should be carefully evaluated only in women with highly active disease who plan a pregnancy or have an unplanned pregnancy, after accurate counseling about eventual maternal disease relapse due to therapy suspension. This brief case report describes a case of documented anemia that we observed in a newborn whose mother with relapsing-remitting multiple sclerosis was treated with an extended dosing protocol of natalizumab throughout pregnancy. The newborn received the infusion of erythropoietin every seven days from the fortieth day of life; subsequently, the status of anemia underwent clinical resolution. This case report confirmed that natalizumab can cause disorders of hematopoiesis, including anemia, thrombocytopenia, or pancytopenia, in newborns of patients treated during pregnancy. A multidisciplinary team, including experienced pediatricians and pediatric hematologists, has a critical role in managing newborns delivered by women, being treated with natalizumab for treating relapsing-remitting multiple sclerosis during pregnancy.