Thrombocytopenia in pregnancy

Cines, Douglas B.; Levine, Lisa D.

doi:10.1182/blood-2017-05-781971

Cited by 127 publications

(180 citation statements)

References 54 publications

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“…90 Other agents, such as azathioprine and cyclosporine have been used safely; however, even when effective, these may take considerable time to raise the platelet count. Rituximab is not teratogenic, but may cause prolonged B-cell lymphopenia in offspring.…”

Section: Safety Of Splenectomy In Special Situations Pregnancymentioning

confidence: 99%

“…Rituximab is not teratogenic, but may cause prolonged B-cell lymphopenia in offspring. 90 Splenectomy is rarely used in pregnant patients with ITP; when it is, the optimal time is in the mid-second trimester to minimize the risk of premature labor and provide access to the spleen before it is obscured by the gravid uterus.…”

Section: Safety Of Splenectomy In Special Situations Pregnancymentioning

confidence: 99%

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Splenectomy for immune thrombocytopenia: down but not out

Chaturvedi

Arnold

McCrae

2018

Blood

156

154

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word count: 239Word count: 4298 ABSTRACTSplenectomy is an effective therapy for steroid-refractory or dependent immune thrombocytopenia (ITP). With the advent of medical alternatives such as rituximab and thrombopoietin receptor antagonists (TPO-RA), the use of splenectomy has declined and is generally reserved for patients that fail multiple medical therapies. Splenectomy removes the primary site of platelet clearance and autoantibody production, and offers the highest rate of durable response (50-70%) compared to other ITP therapies. However, there are no reliable predictors of splenectomy response, and long-term risks of infection and cardiovascular complications must be considered. Since the long-term efficacy of different second-line medical therapies for ITP have not been directly compared, treatment decisions must be made without supportive evidence. Splenectomy continues to be a reasonable treatment option for many patients, including those with an active lifestyle who desire freedom from medication and monitoring, and patients with fulminant ITP that does not respond well to medical therapy. We try to avoid splenectomy within the first 12 months after ITP diagnosis for most patients to allow for spontaneous or therapy-induced remissions, particularly in older patients who have increased surgical morbidity and lower rates of response, and in young children. Treatment decisions must be individualized based on patients' comorbidities, lifestyles and preferences. Future research should focus on comparing long-term outcomes of patients treated with different second line therapies, and on developing personalized medicine approaches to identify subsets of patients most likely to respond to splenectomy or other therapeutic approaches.

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Section: Safety Of Splenectomy In Special Situations Pregnancymentioning

confidence: 99%

Section: Safety Of Splenectomy In Special Situations Pregnancymentioning

confidence: 99%

Splenectomy for immune thrombocytopenia: down but not out

Chaturvedi

Arnold

McCrae

2018

Blood

156

154

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“…Gestational thrombocytopenia occurs in 4.4–11.6% of pregnancies and is not commonly associated with maternal and fetal morbidities . Gestational thrombocytopenia is defined as a platelet count of <150 × 10 9 /L, and 1–5% of women develop platelet count of less than that during pregnancy . Therefore, platelet counts of <150 × 10 9 /L and ≥100 × 10 9 /L may not reflect maternal organ damage in women with pre‐eclampsia, particularly when other maternal organ damage is not observed, and a platelet count of <100 × 10 9 /L might be a better threshold to indicate maternal organ damage.…”

Section: Discussionmentioning

confidence: 99%

Increase in the number of patients diagnosed using the new classification of hypertensive disorders of pregnancy in Japan

Mayama

Morikawa

Umazume

et al. 2019

J of Obstet and Gynaecol

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Aim This study aimed to examine how the number of patients diagnosed with pre‐eclampsia increased according to the Japanese classification of hypertensive disorders of pregnancy (HDP) that was revised in 2018. The effect of new classification on perinatal outcomes was also analyzed. Methods We enrolled 181 women with HDP who delivered at Hokkaido University Hospital between February 2011 and December 2017. All women were reclassified on the basis of the new classification, in which proteinuria was not required to diagnose pre‐eclampsia in patients with maternal organ damage. The number and reasons of reclassification and the admission rate to the neonatal intensive care unit (NICU) and gestational age (GA) at the onset of HDP and at delivery were analyzed. Results In this cohort, 17 (9.4%) of 181 women with HDP were reclassified. Low platelet count (41.2%) and uteroplacental dysfunction (41.2%) were the two main causes for reclassification. GA at the onset of HDP (33.6 [29.9–36.1] weeks vs 37.4 [35.7–38.4] weeks; P < 0.001) and at delivery (35.9 [32.4–37.3] weeks vs 38.1 [37.3–39.6] weeks; P < 0.001) were significantly earlier in women with reclassification than women without reclassification. The NICU admission rate was higher in women with reclassification than women without reclassification (70.6% vs 20.4%; P < 0.001). Conclusion Almost 10% of pregnant women were newly diagnosed with pre‐eclampsia as per the new Japanese classification of HDP. Women with reclassification as pre‐eclampsia had a greater risk of preterm delivery and NICU admission than those who were not reclassified.

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“…Most pathologies have a very minimal impact on the offspring, causing neonatal thrombocytopenia in < 2% of all cases. 125,126 Immunologically based thrombocytopenia may present as primary immune thrombocytopenic purpura (ITP) or as alloimmune fetal-neonatal alloimmune thrombocytopenia (FNAIT). ITP with a pregestational history of maternal thrombocytopenia, accounts for only 3% of all thrombocytopenias of pregnancy, with maternal platelet counts being < 50 Â 10 9 /L during the first and second trimester in the majority of the cases.…”

Section: Maternal-fetal Quantitative Platelet Defectsmentioning

confidence: 99%

High-Risk Pregnancies and Their Impact on Neonatal Primary Hemostasis

Politou

Mougiou

Kollia

et al. 2019

Semin Thromb Hemost

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Primary hemostasis, similar to other systems in the adjusting and transitioning neonate, undergoes developmental adaptations in the first days of life. Although platelets of neonates do not differ quantitatively compared with those of adults, they functionally present with major differences, thus supporting the theory of a “hypofunctional” phenotype that is counterbalanced by high hematocrit and more potent von Willebrand factor multimers. No clinical effect of bleeding tendency has hence been established so far for healthy term neonates. However, discrepancies in functionality have been noted, associated with gestational age, with more pronounced platelet hyporesponsiveness in preterm neonates. Multiple methods of in vitro platelet function evaluation such as PFA-100/200, platelet aggregometry, flow cytometry, and cone and platelet analyzer have been used for assessment of neonatal primary hemostasis. Several pregnancies are characterized as “high-risk” when risk factors preexist in maternal history or evolve during pregnancy. These pregnancies require specialized observation as they may have unpredictable outcome. High-risk pregnancies include clinical entities such as preeclampsia, pregnancy-induced smoking during pregnancy, gestational diabetes mellitus (GDM), autoimmune diseases, and other maternal hematological conditions. In some cases, like systemic lupus erythematosus, antiphospholipid antibody syndrome, and maternal immunologically based thrombocytopenia, neonatal thrombocytopenia is regarded as a prominent hemostasis defect, while in others, like pregnancy-induced hypertension and preeclampsia, both quantitative and qualitative disorders of neonatal platelets have been reported. In other pathologies, like GDM, neonatal primary hemostasis remains vastly unexplored, which raises the need for further investigation. The extent to which primary hemostasis is affected in neonates of high-risk pregnancies is the main objective of this narrative review.

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Thrombocytopenia in pregnancy

Cited by 127 publications

References 54 publications

Splenectomy for immune thrombocytopenia: down but not out

Splenectomy for immune thrombocytopenia: down but not out

Increase in the number of patients diagnosed using the new classification of hypertensive disorders of pregnancy in Japan

High-Risk Pregnancies and Their Impact on Neonatal Primary Hemostasis

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