Primary thrombocythemia and pregnancy: Treatment and outcome in fifteen cases

Abstract

Pregnancy in patients with primary thrombocythemia (PT) is reported to be often complicated by recurrent abortion and fetal growth retardation. Fifteen pregnancies in nine patients with PT are reported. Nine pregnancies had a good outcome, with the birth of a healthy infant. There were two spontaneous abortions and three intrauterine deaths. One pregnancy was electively terminated after extensive thrombosis in the splanchnic district requiring surgical entero-resection. In five pregnancies the mother received no treatment; in ten pregnancies acetylsalicylic acid (ASA) was prescribed to the mother as soon as she was found pregnant, subcutaneous heparin was added from the middle trimester in seven cases. In patients treated with ASA and subcutaneous heparin pregnancies had a good outcome. Administration of ASA and heparin during pregnancy appears to improve the outcome in patients with PT and can prevent severe maternal complications , but requires close monitoring.

A single institutional experience with 43 pregnancies in essential thrombocythemia

“…However, very few patients reported in the literature have received aspirin as the only therapy (48), and so a determination of its ef®cacy is problematic. Uncontrolled studies have also suggested the bene®t of heparin and of interferon alfa in reducing the incidence of miscarriages (13,17,20,25,62). The current study clearly showed that pregnancy outcome was not in¯uenced by treatment with aspirin.…”

“…The cause of this phenomenon is unclear but may be similar to that in normal pregnancy, in which platelet counts typically decrease by 10±15% of the pre-pregnancy level from 11 to 15 wk of gestation to 36±40 wk (57,58). Other possible mechanisms include an increase in platelet consumption (17), a hormonal response (45), placental or fetal production of a factor that reduces platelet production (54), and a cytokine-mediated decrease in megakaryocyte number (56).…”

Thrombocytémie essentielle et grossesse

“…Toutefois, certains auteurs contre-indiquent l'aspirine chez les patientes ayant un taux de plaquettes supé rieur à 1 000 000/mL en raison du risque hé morragique augmenté , celles ayant des manifestations hé morragiques ou une maladie de Willebrand acquise [4,5]. L'hé parinothé rapie en relais de l'aspirine durant les derniè res semaines de grossesse paraît avoir un inté rêt [4,7,14]. Cependant, nous ne disposons pas de donné es suffisantes pour dé terminer à quel moment il convient de l'interrompre avant l'accouchement.…”

Patients with essential thrombocytosis during pregnancy: Challenges and therapeutic dilemmas

“…LMWH was also given when ASA was contraindicated due to increased risk of bleeding. In the majority of cases LMWH was combined with ASA [32,33] especially when there was a thrombotic history or a history of pregnancy complications [28,34,35].…”