Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome

Abstract

Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non-pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. We report three successfully treated patients throughout pregnancy, for differential indications: thrombotic thrombocytopenic purpura, red blood cells alloimmunization and ulcerative colitis. Multiple courses of TA have been performed without any complications for the mother and the fetus. A review and a discussion on the particular TA implications related to maternal-fetal medicine have been reported. When approaching TA in pregnancy, clinicians have to consider the severity of disease, the strength of the indications, and the gestational age. Each case must be evaluated individually on the basis of existing evidence since, despite the increasing use, specific guidelines for apheresis in pregnancy are still lacking.

Therapeutic Plasma Exchange in Early-Onset Preeclampsia: A 7-Year Monocentric Experience

“…This study investigates the experimental treatment of very early preeclampsia with the widespread available therapeutic plasma exchange (TPE) to reduce factors that may negatively affect preeclampsia. A low risk of morbidity and fatalities associated with plasmapheresis has been reported, but the incidence of these complications is not affected by pregnancy [ 18 ]. TPE is a frequently used and established extracorporeal clinical procedure during pregnancy for a large number of indications (e.g., TTP-thrombotic thrombocytopenic purpura, rhesus alloimmunizations, pancreatitis, aHUS-atypic hemolytic uremic syndrome, acute liver failure, catastrophic antiphospholipid syndrome, SLE-systemic lupus erythematosus and SLE-nephritis) [ 19 ].…”

Prevention of Fetal Anemia with Plasma Exchange and Intravenous Immunoglobulin in a Pregnancy with a Complex Anti-K and Anti-C Alloimmunization

“…Therefore, shared protocols between transfusion medicine, obstetrics, neonatology, and hospital pharmacy are essential. 15…”

Therapeutic plasma exchange in pregnancy: A literature review

“…TPE is the first line treatment and should be started as soon as possible to remove anti-ADAMTS-13 autoantibodies as well as replenish ADAMTS-13 [38]. Although in TTP and aHUS similar clinical manifestation and laboratory findings can be found, from a clinical point of view neurologic symptoms are more common in TTP patients, while renal insufficiency is more often seen in aHUS patients [6,39]. The gestational age at which TMA presents during pregnancy can help: aHUS usually presents in the late third trimester or postpartum period, while TTP mostly (but not exclusively) presents earlier [35,36].…”

“…Therefore, we performed a literature review to provide an overview of potential safety issues to which treating physicians can anticipate to and a literature-based framework on the most commonly reported indications for TPE in pregnancy. Since the first report of TPE in pregnancy in 1968, TPE techniques have significantly improved, our knowledge on the pathophysiology of many diseases has expanded, and TPE has gained a more established place in the physician's therapeutic armamentarium for maternal disease during pregnancy [1,2,6,7].…”