Essential thrombocythemia associated with recurrent abortions and fetal growth retardation

Abstract

Essential thrombocythemia (ET) is one of the myeloproliferative disorders characterized by an elevated platelet count, usually greater than 1,000 X 10(9)/L. It may be associated with either hemorrhagic or thrombotic tendencies. Although it usually affects older people, we have recently encountered two young women with ET who had a total of six spontaneous abortions before the end of the first trimester. During her most recent pregnancy, one of the patients underwent plateletpheresis on four separate occasions before the 12th week. She reached 34 weeks but demonstrated evidence of fetal growth retardation and pre-eclampsia. At delivery there were scattered villus infarcts in the placenta. Based on this patient and previous reports in the literature, we postulate that the spontaneous abortions, fetal growth retardation, and pre-eclampsia may be related to the thrombocytosis and suggest that the use of antiplatelet agents throughout pregnancy should be seriously considered in such cases.

Platelet-derived soluble factors induce human extravillous trophoblast migration and differentiation: platelets are a possible regulator of trophoblast infiltration into maternal spiral arteries

“…It was reported that essential thrombocythemia is related to recurrent abortion and fetal growth retardation, suggesting that platelets are deeply involved in early events during embryo implantation. [33][34][35] The data presented here suggest the importance of platelet activation during maternal vascular remodeling, which is considered insufficient in such pathological pregnancies. Although antiplatelet (low-dose aspirin) therapy has been used worldwide for the prophylaxis of preeclampsia and/or intrauterine fetal growth retardation, there are many controversies about its effectiveness.…”

Management of Essential Thrombocythemia during Pregnancy with Aspirin, Interferon Alpha-2a and No Treatment

“…In women with ET there is a significantly higher rate of fetal morbidity and mortality due to placental infarction [6, 17]. These placental infarctions are due to thrombosis and can cause recurrent spontaneous abortions (mostly in the first trimester) [12, 17, 28, 29, 33, 34, 35], IUFGR (small-for-date babies) [17, 28, 35]and stillbirth (IUFD) [17, 28, 34, 35, 36]. Premature delivery was also described [34, 35].…”

Essential thrombocythemia in pregnancy: Platelet count and pregnancy outcome

“…Essential thrombocythemia complicating pregnancy is a rare and a high risk event. Successful pregnancy outcome as well as fetal retardation, spontaneous abortion, and stillbirth have been previously described [5,6].…”

“…Falconer et al [5] reported 2 cases of ET with 6 spontaneous abortions, but the diagnostic criteria of ET were not specified. Ferrari et al [6], in a letter, reported a woman with ET who had an intrauterine death at term.…”