SOMANZ Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

Darbepoetin Therapy for Symptomatic Anaemia and Orthostatic Intolerance in Pregnancy with Beta-Thalassemia Trait (#178)

Nik Nur Iman Nik Ghazali 1 , Adam Morton 1
  1. Obstetric Medicine, Mater Mothers' Hospital, Brisbane, QLD, Australia

Background:
Beta-thalassemia trait in pregnancy may impair red cell mass expansion, leading to symptomatic anaemia and orthostatic intolerance. Erythropoiesis-stimulating agents (ESAs) such as darbepoetin may be effective in selected cases.

 

Case Presentation:
A 39-year-old G6P3 woman with beta-thalassemia trait presented in the late second trimester with disabling orthostatic presyncope and palpitations. Initial investigations revealed anaemia with normal iron studies, B12, and folate. Progress haemoglobin (Hb) and ferritin levels are shown in Figure 1. Despite iron infusion at 27 weeks’ gestation, symptoms persisted. Examination showed postural tachycardia (Heart rate 90 →120 bpm; from sitting to standing) without hypotension or dysautonomia. Serum cortisol was normal (466 mmol/L) and erythropoietin level was inappropriately low (20 mIU/mL). Non-pharmacological interventions and fludrocortisone (0.3 mg/day) were ineffective. Following informed consent, 30 mcg darbepoetin was administered, resulting in rapid symptoms resolution and increase in Hb to 105 g/L. She delivered at 38 weeks following spontaneous rupture of membranes, without complications.

 

Discussion:
Pregnant women with beta-thalassemia trait often develop worsening anemia due to ineffective erythropoiesis.1 Although erythropoietin levels increase during pregnancy, the response may be insufficient to correct the anaemia.2 In selected cases, the use of ESAs such as darbepoetin has shown benefit.3 Additionally, in non-pregnant individuals with POTS refractory to standard treatments, 71% showed symptom improvement with erythropoietin.4 It has also shown benefit in dysautonomia-associated anaemia and orthostatic intolerance.⁵⁻⁸

 

Conclusion:
Darbepoetin may be an effective option in beta-thalassemia trait pregnancies with symptomatic anaemia and orthostatic intolerance unresponsive to conventional therapy.

 

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