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FRCPath Haem Part 1 MCQ-Gen Haem 398

A 30yr-old pt with PNH is 20 weeks pregnant. She has been on Ravulizumab for the past 12 months. labs: Hb: 88g/L, LDH 600IU and no thrombosis. Best Next step?

  • Continue Ravulizumab throughout pregnancy

  • Stop Ravilizumab and manage with transfusion

  • Switch to Crovalimab

  • Switch to Eculizumab


 
 
 

1 Comment

adwaanhemay
4 hours ago

Correct Answer: Switch To Eculizumab


Explanation:

Ravulizumab is not recommended in pregnancy due to insufficient safety data. Eculizumab is the preferred C5 inhibitor in pregnant patients with PNH.

In this case:

  • 20 weeks pregnant

  • Hb 88 g/L

  • LDH 600 IU/L → ongoing hemolysis

  • On Ravulizumab


✅ Best Next Step:

Switch from Ravulizumab to eculizumab.


Why?

  • Eculizumab has established safety data in pregnancy

  • It reduces maternal thrombosis risk and improves fetal outcomes

  • Ravulizumab lacks sufficient pregnancy safety evidence

After switching:

  • Monitor LDH closely

  • Dose-adjust eculizumab during pregnancy (often requires shorter intervals)


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