Severe gestational (incidental) thrombocytopenia: To treat or not to treat

Win, Nyo Mie; Rowley, Mark; Pollard, Cecil; Beard, J. B.; Hambley, H.; Booker, Michael

doi:10.1080/10245330400020421

Cited by 31 publications

(27 citation statements)

References 13 publications

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“…We consider a diagnosis of gestational thrombocytopenia unlikely if the platelet count is Ͻ 50 ϫ 10 9 /L, with very few cases having been described with counts 40-50 ϫ 10 9 /L. 7,8 For the thrombocytopenia to be consistent with gestational thrombocytopenia, women should have no past history of thrombocytopenia (except during a previous pregnancy), the thrombocytopenia resolved spontaneously within 1-2 months after delivery, and the fetus/newborn baby should not have had thrombocytopenia (Table 2). 9 ITP is the second most common cause of an isolated low platelet count in pregnancy, accounting for ϳ 3% of women who are thrombocytopenic at delivery.…”

Section: What Are the Most Probable Etiologies Of Her Thrombocytopenia?mentioning

confidence: 99%

How I treat thrombocytopenia in pregnancy

Gernsheimer

James

Stasi

2013

Blood

228

213

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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)

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Section: What Are the Most Probable Etiologies Of Her Thrombocytopenia?mentioning

confidence: 99%

How I treat thrombocytopenia in pregnancy

Gernsheimer

James

Stasi

2013

Blood

228

213

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“…(6) GT does not respond to IV immune globulin (IVIG) or corticosteroids, which has been tried when thrombocytopenia is so severe as to compromise epidural anesthesia or delivery. 13 (7) If thrombocytopenia does not resolve within 1 to 2 months of delivery, the diagnosis of ITP or HT may become evident only in hindsight.…”

Section: Gestational Thrombocytopeniamentioning

confidence: 99%

Thrombocytopenia in pregnancy

Cines¹,

Levine

2017

Blood

127

137

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Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances made over the past 5 to 10 years in understanding and managing the more common causes of thrombocytopenia in pregnancy. Recent trends in the management of immune thrombocytopenia translate into more women contemplating pregnancy while on treatment with thrombopoietin receptor agonists, rituximab, or mycophenylate, which pose known or unknown risks to the fetus. New criteria to diagnose preeclampsia, judicious reliance on measurement of ADAMTS13 to make management decisions in suspected thrombotic thrombocytopenic purpura, new evidence supporting the efficacy and safety of anticomplement therapy for atypical hemolytic uremic syndrome during pregnancy, and implications of thrombotic microangiopathies for subsequent pregnancies are evolving rapidly. The goals of the chapter are to help the hematology consultant work through the differential diagnosis of thrombocytopenia in pregnancy based on trimester of presentation, severity of thrombocytopenia, and coincident clinical and laboratory manifestations, and to provide guidance for dealing with some of the more common and difficult diagnostic and management decisions.

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“…It is a diagnosis of exclusion, generally causes only mild thrombocytopenia, and occurs in the latter half of pregnancy, from midsecond or third trimester. However, there are reports of more severe thrombocytopenia which showed no response to steroids (standard treatment for ITP) and which resolved postnatally, consistent with gestational thrombocytopenia 7 . Most experts consider this diagnosis less likely if the platelet count falls below 70 × 10 9 /L; the main differential diagnosis at this level or lower is immune thrombocytopenia (ITP).…”

Section: Gestational Thrombocytopenia (Incidental Thrombocytopenia)mentioning

confidence: 99%

Diagnosis and Management of Thrombocytopenia in Pregnancy

Myers

Truelove

2011

Fet. Matern. Med. Rev.

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Platelets are an essential component of the first step in the process of haemostasis, plugging defects in the endothelium and providing a surface for secondary haemostasis to occur, via the coagulation pathway. Platelet aggregation and activation cause granule release of von Willebrand factor, ADP and serotonin, which, in turn, results in recruitment of more platelets to form the platelet plug. This serves to stop the bleeding, and also to activate the coagulation pathway on the surface of the activated platelets, leading to a firm fibrin clot.

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Severe gestational (incidental) thrombocytopenia: To treat or not to treat

Cited by 31 publications

References 13 publications

How I treat thrombocytopenia in pregnancy

How I treat thrombocytopenia in pregnancy

Thrombocytopenia in pregnancy

Diagnosis and Management of Thrombocytopenia in Pregnancy

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