5 Yearsʼ Experience of a Tertiary Center with Thrombocytopenic Pregnancies: Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura and Hypertensive Disorders of Pregnancy

Abstract

Aim To evaluate thrombocytopenic pregnancies including gestational thrombocytopenia (GT), idiopathic thrombocytopenic purpura (ITP), and hypertensive disorders of pregnancy (HDP). Materials and Methods We evaluated the pregnancy outcomes and laboratory findings of 385 patients diagnosed with GT, ITP, or HDP whose thrombocyte levels were < 150 000/µL. Results GT, ITP, and HDP were the final diagnoses in 315 (81.8%), 35 (9.1%), and 35 (9.1%) cases, respectively. Patients diagnosed during the 1st trimester and diagnosed with ITP had significantly lower minimal platelet counts during the antenatal period and prior to delivery (p < 0.001; p < 0.001; p < 0.001; p < 0.001). Transfusion of any kind of blood product was given in 9.9% (n = 38) of all cases. Twelve patients had methylprednisolone and/or intravenous immunoglobulin treatments during the antenatal period. All patients who had undergone medical treatment were also found to have ITP. Four out of 385 patients underwent hysterectomy post partum due to refractory hemorrhage. Analysis of newborn platelet levels showed no statistical differences between any of the groups. Despite the lack of statistical significance, the rate of thrombocytopenia in newborns was 50% in patients with severe thrombocytopenia, while rates were 25.6 and 18.1% in patients with moderate and mild thrombocytopenia, respectively. Conclusion Thrombocytopenic pregnancies must be carefully evaluated with regard to the severity of thrombocytopenia, gestational period at initial diagnosis, and etiology. In particular, patients with ITP must be evaluated carefully as these patients are more likely to require transfusions and have platelet counts < 50 × 103/µl.

Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy

“…Most of the cases with platelet counts below 50*10 9 /L occurred in the relatively early stage of pregnancy, with most of the cases being ITP in pregnancy. It has been shown ( 6 ) that approximately 80% of patients were first diagnosed with ITP in early pregnancy, and the median, minimum platelet count during pregnancy was 56*10 9 /L, which was similar to the percentage of 76.39% of patients in group A in the present study. In contrast, in patients who developed thrombocytopenia in the later stage of pregnancy, platelet counts were mostly in the range of 50*10 9 /L to 100*10 9 /L ( p = 0.00).…”

Manajemen Anestesi pada Seksio Sesarea dengan Idiopathic Thrombocytopenic Purpura: Serial kasus

“…Secara khusus, pasien dengan ITP harus dievaluasi dengan hati-hati dan mungkin membutuhkan transfusi jika jumlah trombosit < 50.000 /µL. 11 Terapi lini pertama untuk ITP yaitu pemberian kortikosteroid (prednisolon 1 mg/kg) dan immunoglobulin intravena 1-2 gram/kg yang diberikan selama 1-5 hari. Terapi rumatan dapat diberikan kombinasi danazol 10-15 mg/kg dan azathioprine 2 mg/kg yang diberikan secara per oral.…”

Contraverted questions of management of pregnancy with immune thrombocytopenia

“…Тяжкою ТП названо за наявності симптомів кровотечі при маніфе стації або появі нових геморагічних симптомів, що потребують додаткових терапевтичних при значень -зміни препарату, що підвищує тром боцити, або збільшення дози [19]. Однак у знач ній кількості публікацій тяжкість ТП визначено, як і раніше, за кількістю тромбоцитів: легка -100-150x10 9 /л, середня -50-100x10 9 /л, тяжка -<50x10 9 /л [5,14].…”