Immunosuppressive Drugs and the Foetus

Section: Discussionmentioning

confidence: 99%

A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

Kong

Qin

Xiao

et al. 2017

“…Corticosteroids and IVIg are the first-line treatments for maternal ITP. 143 The limited evidence for the use of IV anti-D, 147,148 splenectomy, and azathioprine [149][150][151] is presented in the subsections that follow. Vinca alkaloids, rituximab, danazol, TPO-receptor agonists, and most immunosuppressive drugs (other than azathioprine) should not be used during pregnancy because of possible teratogenicity.…”

Section: Recommended Treatment Options For the Management Of Itp In Pmentioning

confidence: 99%

“…HDMP (1000 mg) possibly in combination with IVIg or azathioprine has been suggested as a treatment for pregnant patients refractory to oral corticosteroids or IVIg 143 (evidence level III). Data available for azathioprine in SLE and renal transplantation show that it is safe during pregnancy [149][150][151] (evidence level III) but response is slow. Cyclosporin A has not been associated with significant toxicity to mother or fetus during pregnancy.…”

Section: Recommended Treatment Options For the Management Of Itp In Pmentioning

confidence: 99%

International consensus report on the investigation and management of primary immune thrombocytopenia

Provan¹,

Stasi

Newland³

et al. 2010

1,835

1,954

IntroductionPrimary immune thrombocytopenia (ITP) is an acquired immunemediated disorder characterized by isolated thrombocytopenia, defined as a peripheral blood platelet count less than 100 ϫ 10 9 /L, and the absence of any obvious initiating and/or underlying cause of the thrombocytopenia. 1 Until recently, the abbreviation ITP stood for idiopathic thrombocytopenic purpura, but current awareness relating to the immune-mediated nature of the disease, and the absence or minimal signs of bleeding in a large proportion of cases have led to a revision of the terminology. 1 Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of increased platelet destruction mediated by autoantibodies to more complex mechanisms in which both impaired platelet production and T cell-mediated effects play a role. [2][3][4][5][6] Recent epidemiologic data suggest that the incidence in adults is approximately equal for the sexes except in the mid-adult years (30-60 years), when the disease is more prevalent in women. 7,8 ITP is classified by duration into newly diagnosed, persistent (3-12 months' duration) and chronic (Ն 12 months' duration). 1 Whereas ITP in adults typically has an insidious onset with no preceding viral or other illness and it normally follows a chronic course, 9 ITP in children is usually short-lived with at least two-thirds recovering spontaneously within 6 months. 10 Signs and symptoms vary widely. Many patients have either no symptoms or minimal bruising, whereas others experience serious bleeding, which may include gastrointestinal hemorrhage (GI), extensive skin and mucosal hemorrhage, or intracranial hemorrhage (ICH). The severity of thrombocytopenia correlates to some extent but not completely with the bleeding risk. 7,11 Additional factors (eg, age, lifestyle factors, uremia) affect the risk and should be evaluated before the appropriate management is determined.The investigation and management of ITP patients vary widely. The purpose of this consensus document is to comment on new data and provide recommendations relating to diagnosis and treatment. Final judgment regarding care of individual patients should, however, lie with the responsible health care professional and be based on careful investigation of individual circumstances. MethodsComposition of the panel. The panel included 22 members with recognized clinical and research expertise in ITP representing North America (United States, 7; Canada, 1), Europe (France, 1; Italy, 2; Spain, 1; Switzerland, 1; United Kingdom, 8), and Australia (1).Assessment of the literature. Articles were identified by a computer-assisted search of the literature published in English using the National Library of Medicine PubMed database. The For personal use only. on May 7, 2018. by guest www.bloodjournal.org From search criteria were: 'immune thrombocytopenic purpura', 'idiopathic thrombocytopenic purpura', 'ITP', and 'autoimmune thrombocytopenic purpura'. A subsequent search was performed using the corresponding MedLin...

“…Azathioprine has been safely administered during pregnancy. 25,26 Although immune impairment has been reported in some exposed infants, 27 it is a reasonably safe option. High-dose methylprednisolone may also be used in combination with IVIg or azathioprine for the patient who is refractory to oral corticosteroids or IVIg alone or has a less than adequate response.…”

Section: What Treatments Are Safe During Pregnancy?mentioning

confidence: 99%

How I treat thrombocytopenia in pregnancy

Gernsheimer

James

Stasi

2013

228

213

A mild thrombocytopenia is relatively frequent during pregnancy and has generally no consequences for either the mother or the fetus. Although representing no threat in the majority of patients, thrombocytopenia may result from a range of pathologic conditions requiring closer monitoring and possible therapy. Two clinical scenarios are particularly relevant for their prevalence and the issues relating to their management. The first is the presence of isolated thrombocytopenia and the differential diagnosis between primary immune thrombocytopenia and gestational thrombocytopenia. The second is thrombocytopenia associated with preeclampsia and its lookalikes and their distinction from thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. In this review, we describe a systematic approach to the diagnosis and treatment of these disease entities using a case presentation format. Our discussion includes the antenatal and perinatal management of both the mother and fetus. (Blood. 2013; 121(1):38-47)