Numerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 ؋ 10 9 /L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 ؋ 10 9 /L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 ؋ 10 9 /L; 25.2% of infants had platelet counts lower than 150 ؋ 10 9 /L, and 9% had platelet counts lower than 50 ؋ 10 9 /L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts. ( IntroductionIdiopathic thrombocytopenic purpura (ITP) frequently occurs in young women. Consequently, hematologists often treat pregnant women who have a diagnosis or a history of ITP. 1 It is now recognized that, in many patients, the disease is caused by platelet autoantibodies that can cross the placenta and produce thrombocytopenia in some infants. 2 In the past decade, our understanding of ITP in pregnancy has improved; however, in almost all studies, the focus has been on the infant. We now recognize that most of these infants do not have severe thrombocytopenia and that they can be safely delivered vaginally. 3 There has not been much information about ITP outcomes in obstetric patients, including their hemostatic risk at delivery and the likelihood of needing treatment during pregnancy. For this reason, we reviewed the outcomes of pregnant patients with ITP treated over a period of 11 years in the 2 obstetric units of Hamilton hospitals affiliated with McMaster University. We found that mothers with very low platelet counts can successfully deliver healthy infants and that though maternal and fetal bleeding can occur, such complications are uncommon. Patients, materials, and methodsA retrospective chart review was performed for all obstetric patients with ITP who were treated and delivered at the 2 hospitals with obstetric services in Hamilton, Ontario, from January 1, 1990, to December 31, 2000. Patients were eligible for the study if they met the inclusion criteria of pregnancy with a diagnosis of ITP or pregnancy with a previous history of ITP. They were considered to have ITP if they had a history of thrombocytopenia for which other causes were excluded. Other causes of thrombocytopenia included sepsis, pre...

We employ a clinical multiphoton microscope to monitor in vivo and noninvasively the changes in reduced nicotinamide adenine dinucleotide (NADH) fluorescence of human epidermal cells during arterial occlusion. We correlate these results with measurements of tissue oxy-and deoxyhemoglobin concentration during oxygen deprivation using spatial frequency domain imaging. During arterial occlusion, a decrease in oxyhemoglobin corresponds to an increase in NADH fluorescence in the basal epidermal cells, implying a reduction in basal cell oxidative phosphorylation. The ischemia-induced oxygen deprivation is associated with a strong increase in NADH fluorescence of keratinocytes in layers close to the stratum basale, whereas keratinocytes from epidermal layers closer to the skin surface are not affected. Spatial frequency domain imaging optical property measurements, combined with a multilayer Monte Carlo-based radiative transport model of multiphoton microscopy signal collection in skin, establish that localized tissue optical property changes during occlusion do not impact the observed NADH signal increase. This outcome supports the hypothesis that the vascular contribution to the basal layer oxygen supply is significant and these cells engage in oxidative metabolism. Keratinocytes in the more superficial stratum granulosum are either supplied by atmospheric oxygen or are functionally anaerobic. Based on combined hemodynamic and two-photon excited fluorescence data, the oxygen consumption rate in the stratum basale is estimated to be ~0.035 mmoles/10 6 cells/h.

We employ a clinical multiphoton microscope to monitor in vivo and noninvasively the changes in reduced nicotinamide adenine dinucleotide (NADH) fluorescence of human epidermal cells during arterial occlusion. We correlate these results with measurements of tissue oxy-and deoxyhemoglobin concentration during oxygen deprivation using spatial frequency domain imaging. During arterial occlusion, a decrease in oxyhemoglobin corresponds to an increase in NADH fluorescence in the basal epidermal cells, implying a reduction in basal cell oxidative phosphorylation. The ischemia-induced oxygen deprivation is associated with a strong increase in NADH fluorescence of keratinocytes in layers close to the stratum basale, whereas keratinocytes from epidermal layers closer to the skin surface are not affected. Spatial frequency domain imaging optical property measurements, combined with a multilayer Monte Carlo-based radiative transport model of multiphoton microscopy signal collection in skin, establish that localized tissue optical property changes during occlusion do not impact the observed NADH signal increase. This outcome supports the hypothesis that the vascular contribution to the basal layer oxygen supply is significant and these cells engage in oxidative metabolism. Keratinocytes in the more superficial stratum granulosum are either supplied by atmospheric oxygen or are functionally anaerobic. Based on combined hemodynamic and two-photon excited fluorescence data, the oxygen consumption rate in the stratum basale is estimated to be~0.035 mmoles/10 6 cells/h.