Risk of Thrombocytopenia in the Infants of Mothers with Idiopathic Thrombocytopenia

Abstract

Twenty-nine of 27,662 pregnant women had autoimmune thrombocytopenia at the time of delivery at King Khalid University Hospital over 6 years starting June 1986. Twenty-six had idiopathic thrombocytopenic purpura (ITP), gave birth to 33 infants, of which 22 were by spontaneous vaginal delivery, eight by lower segment cesarean section, and two by forceps. Fourteen (44%) of the 32 living infants had platelets less than 150 x 10(9)/L and four (12.5%) had severe thrombocytopenia (platelets less than 50 x 10(9)/L). The mothers' platelets of less than 50 x 10(9)/L at delivery were found to be predictive of thrombocytopenia in their infants (P < 0.027), compared with mothers' platelet of more than 50 x 10(9)/L. Maternal treatment with prednisone did not seem to have significant effect on infants' platelets (P < 0.89). All infants with severe thrombocytopenia (less than 50 x 10(9)/L) at birth had ultrasound done and were found to be normal. We conclude that: (1) steroid given to pregnant women with ITP does not increase infants' platelet counts, (2) severe thrombocytopenia in the mothers (platelet counts less than 50 x 10(9)/L) is highly predictive of thrombocytopenia in their infants; (3) cesarean section should be limited to the mother with severe thrombocytopenia if fetal scalp platelets are less than 50 x 10(9)/L.

Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic purpura

“…In agreement with other studies, we found severe neonatal thrombocytopenia in a sibling a risk factor for severe neonatal thrombocytopenia . We also observed an association with a low maternal platelet count during pregnancy . Evidence about associations between neonatal platelet counts and several maternal factors is conflicting, as most large studies show a lack of association with maternal platelets, antibodies and timing of diagnosis, whereas more severe neonatal thrombocytopenia in mothers who underwent splenectomy was quite frequently described .…”

“…ITP is considered to be caused by autoantibodies (IgG) against nonpolymorphic platelet antigens, although antibodies cannot be detected in all women with ITP. Hypothetically, these IgG antibodies can be transported through the placenta and can cause destruction of fetal platelets, but evidence for this hypothesis lacks . Severe thrombocytopenia (<50 × 10 9 /l) in infants of mothers with ITP is, however, present in only 8–13% of the neonates.…”

“…The natural course of platelet counts in neonates of mothers with ITP describes a platelet nadir at postnatal day 3–5, after which platelets will stabilize or rise spontaneously . However, the optimal postnatal treatment for severe neonatal thrombocytopenia is not evident and includes IVIG, platelet transfusions and/or prednisone . Evidence on the neonatal outcome, risk factors and optimal management is scarce due to lack of studies.…”

Successful Management of Severe Idiopathic Thrombocytopenia in the Second Trimester of Pregnancy

“…The identification of the fetus at risk would be important because a vaginal delivery is safer for the thrombocytopenic mother. It is accepted that the majority of babies from mothers with ITP have normal platelet counts, although Al Mofada et al [8] studied 29 women with autoimmune thrombocytopenia and reached the conclusion that severe thrombocytopenia in the mothers is highly predictive of thrombocytopenia in their infants. In our case, the discrepancy between maternal and fetal platelets was remarkable (also noticeable are the early diagnosis of severe thrombocytopenia, the poor response to medical treatment and the persistence of threat to the mother's health for more than 1 month post partum).…”

Guidelines on the treatment of primary immune thrombocytopenia in children and adolescents: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Guidelines Project: Associação Médica Brasileira - 2012

“…Three newborns with clinical manifestations had platelet counts of less than 15 x 10 9 /L and skin bleeding, umbilical cord bleeding or gastric bleeding; all received IVIg and prednisone, as well as platelet transfusions in cases of more important hemorrhages. All children with platelet counts ≤ 50 x 10 9 /L received IVIg and prednisone (58) (C).…”