Letter to the editor: Essential thrombocythemia and complications of pregnancy

Abstract

Recent reviews support the observation that essential thrombocytosis in young patients is not always without risk. Thrombotic complications include acute myocardial infarction and stroke [l, 21 in addition to recurrent abortions and stillbirths presumably related to placental infarction [3-51. At the time of our previous report, our second patient had been lost to follow-up. She recently was seen in another centre at which time she was pregnant for the eighth time. She reported a total of seven spontaneous abortions occurring around the end of the first trimester. The platelet count was 669-714 X 109/L. She was placed on aspirin 325 mg daily and continued on this through pregnancy. She presented to the hospital at 38 weeks with mild pregnancy-induced hypertension and evidence of intrauterine growth retardation. A female infant weighing 2.325 kg was delivered by cesarean section (Apgar at 1 and 5 min, 8 and 9). Examination of the placenta revealed a large, old subchorionic infarction. After a short stay in the neonatal intensive care unit, the infant was discharged with the mother. Postpartum, the platelet count remained elevated at 942 X 109/L. These observations further support the hypothesis that essential thrombocythemia predisposes to spontaneous abortions and stillbirths, presumably by causing placental infarctions, and that aspirin given throughout the pregnancy can lead to a favorable outcome.of Pregnancy

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

“…Those who prescribed regular aspirin discontinued the medication 2 weeks before delivery [6, 10, 12, 13, 14, 17, 23, 26, 27, 29, 31]. In some of these cases, LMWH was then commenced [10, 17, 23, 29, 31, 33].…”

Intracranial Hemorrhage and Hydrops in the Fetus of a Mother with Thrombocytosis: Implications for Possible Pathogenetic Factors and Therapy

“…In accordance with these observations, multiple focal infarctions were also detected in the pathological examination of our placenta. This has been primarily described in association with late fetal loss [10] , preterm delivery [10,11] and in- trauterine growth restriction [12][13][14][15] . Niittyvuopio et al [16] and other previous studies have shown that pregnancy-related complications in ET are difficult to predict [16][17][18] .…”

Patients with essential thrombocytosis during pregnancy: Challenges and therapeutic dilemmas

“…There are reports in patients with a history of abortions that had a successful pregnancy after single treatment with ASA [5,6,8,9,16,[19][20][21][22][23][24][25]. ASA was also initiated in some cases, if not at the beginning of pregnancy, when a pregnancy complication was present like hypertension disorders, abrutio placenta or IUGR and premature delivery [5,8,[25][26][27].…”