In a pregnant patient with PNH without aplastic anemia who has residual hemolysis while on ravulizumab and on prophylactic LMWH, what else can be done to reduce thrombotic risk and improve maternofetal outcomes?

Personally, I feel that C5 inhibitors are now close to obsolete in the management of PNH, since C3 and factor B inhibitors are more effective and inhibit both intravascular and extravascular hemolysis. Whether or not to use pegcetacoplan or iptacopan depends on the trimester, the seriousness of the PNH, and the comfort of the mother and the treating physicians, since little data exist. Neither drug is mutagenic in animals. Pegcetacoplan crosses the placenta in minimal amounts. I think that if th...