Immune thrombocytopenic purpura in pregnancy

Current Opinion in Hematology

Volumn 14, Issue 5, 2007, Pages 574-580

  Gernsheimer, Terry ^a,c   McCrae, Keith R ^b  

^a UNIVERSITY OF WASHINGTON   (United States)

^b CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c PUGET SOUND BLOOD CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CORTICOSTEROID; CYCLOPHOSPHAMIDE; DANAZOL; IMMUNOGLOBULIN; RHESUS D ANTIBODY; RITUXIMAB; VINCA ALKALOID;

CORTICOSTEROID THERAPY; DISEASE SEVERITY; GESTATION PERIOD; HUMAN; IDIOPATHIC THROMBOCYTOPENIC PURPURA; IMMUNOTHERAPY; LAPAROSCOPIC SURGERY; PREGNANCY; PRIORITY JOURNAL; REVIEW; SCREENING; SPLENECTOMY; THROMBOCYTE COUNT; THROMBOCYTOPENIA;

ADRENAL CORTEX HORMONES; DELIVERY, OBSTETRIC; FEMALE; GESTATIONAL AGE; GREAT BRITAIN; HEMATOLOGY; HEMORRHAGE; HUMANS; IMMUNOGLOBULINS, INTRAVENOUS; IMMUNOLOGIC FACTORS; LAPAROSCOPY; PLATELET COUNT; PRACTICE GUIDELINES AS TOPIC; PREGNANCY; PREGNANCY COMPLICATIONS, HEMATOLOGIC; PREGNANCY OUTCOME; PREGNANCY TRIMESTER, THIRD; PURPURA, THROMBOCYTOPENIC, IDIOPATHIC; SEVERITY OF ILLNESS INDEX; SOCIETIES, MEDICAL; SPLENECTOMY; UNITED STATES;

EID: 34648833769     PISSN: 10656251     EISSN: 15317048     Source Type: Journal    
DOI: 10.1097/MOH.0b013e3282bf6dc2     Document Type: Review

References (33)

1. McCrae KR. Thrombocytopenia in pregnancy. In: Platelets. 2nd ed. New York: Elsevier; 2006.
2. McCrae KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Rev 2003; 17:7-14.
3. Boehlen F, Hohlfeld P, Extermann P, et al. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 2000; 95:29-33.
4. Sainio S, Kekomaki R, Riikonen S, Teramo K. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 2000; 79:744-749. This manuscript describes a population-based surveillance study of the platelet counts of 4382 women with full-term pregnancies. A total of 317 women had platelet counts of less than 150 000/μl. Eighty-one percent of these cases were due to gestational thrombocytopenia. ITP accounted for approximately 3%.
5. Burrows RF, Kelton JG. Incidentally detected thrombocytopenia in healthy mothers and their infants. N Engl J Med 1988; 319:142-145.
6. Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J Obstet Gynecol 1990; 162:731-734. In this paper, thrombocytopenia developed in 513 of 6715 consecutive deliveries over a 3-year interval. The most common cause was incidental thrombocytopenia (65.1%). Obstetrical or medical conditions such as premature labor or diabetes accounted for 13.1% of thrombocytopenia cases, while hypertensive or immune disorders accounted for 21%. This manuscript identified incidental thrombocytopenia as the most common cause of thrombocytopenia during pregnancy.
7. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993; 329:1463-1466.
8. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88:3-40.
9. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003, 120:574-596.
10. Webert KE, Mittal R, Sigouin C, et al. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102:4306-4311. This manuscript describes the course of 92 pregnant women with ITP followed over an 11-year period. Women in 37 pregnancies required treatment, and 44 patients received epidural anesthesia. The incidence of bleeding and fetal outcomes are described and discussed.
11. Oshiro BT, Silver RM, Scott JR, et al. Antiphospholipid antibodies and fetal death. Obstet Gynecol 1996; 87:489-493.
12. Devendra K, Koh LP. Pregnancy in women with idiopathic thrombocytopaenic purpura. Ann Acad Med Singapore 2002; 31:276-280.
13. Won YW, Moon W, Yun YS, et al. Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura (ITP). Korean J Intern Med 2005; 20:129-134.
14. Boehlen F, Hohlfeld P, Extermann P, de Moerloose P. Maternal antiplatelet antibodies in predicting risk of neonatal thrombocytopenia. Obstet Gynecol 1999; 93:169-173.
15. Samuels P, Bussel JB, Braitman LE, et al. Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura. N Engl J Med 1990; 323:229-235.
16. Fujimura K, Harada Y, Fujimoto T, et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int J Hematol 2002; 75:426-433. This study describes the clinical courses of 284 pregnant patients with ITP through a retrospective nationwide study. Bleeding occurred in 6.3%of neonates, but was not severe. The offspring of patients who were previously splenectomized mothers developed ITP more frequently, a finding reported in some, but not all reports. A higher complication rate was observed in mothers who received higher doses of steroids, as well as their offspring.
17. Ajzenberg N, Dreyfus M, Kaplan C, et al. Pregnancy-associated thrombocytopenia revisited: assessment and follow-up of 50 cases. Blood 1998; 92:4573-4580.
18. Griffiths J, Sia W, Shapiro AM, et al. Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. J Obstet Gynaecol Can 2005; 27:771-774.
19. Michel M, Novoa MV, Bussel JB. Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. Br J Haematol 2003; 123:142-146.
20. Kimby E, Sverrisdottir A, Elinder G. Safety of rituximab therapy during the first trimester of pregnancy: a case history. Eur J Haematol 2004; 72:292-295.
21. Herold M, Schnohr S, Bittrich H. Efficacy and safety of a combined rituximab chemotherapy during pregnancy. J Clin Oncol 2001; 19:3439.
22. de Boer NK, Jarbandhan SV, de Graaf P, et al. Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites. Am J Gastroenterol 2006; 101:1390-1392.
23. Ghidini A, Sepulveda W, Lockwood CJ, Romero R. Complications of fetal blood sampling. Am J Obstet Gynecol 1993; 168:1339-1344.
24. Beilin Y, Zahn J, Comerford M. Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm(-3). Anesth Analg 1997; 85:385-388.
25. Peleg D, Hunter SK. Perinatal management of women with immune thrombocytopenic purpura: survey of United States perinatologists. Am J Obstet Gynecol 1999; 180:645-649.
26. al-Mofada SM, Osman ME, Kides E, et al. Risk of thrombocytopenia in the infants of mothers with idiopathic thrombocytopenia. Am J Perinatol 1994; 11:423-426.
27. Payne SD, Resnik R, Moore TR, et al. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia. Am J Obstet Gynecol 1997; 177:149-155.
28. Christiaens GC, Nieuwenhuis HK, von dem Borne AE, et al. Idiopathic thrombocytopenic purpura in pregnancy: a randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count. Br J Obstet Gynaecol 1990; 97:893-898.
29. Yamada H, Fujimoto S. Perinatal management of idiopathic thrombocytopenic purpura in pregnancy: risk factors for passive immune thrombocytopenia. Ann Hematol 1994; 68:39-42.
30. Christiaens GC, Nieuwenhuis HK, Bussel JB. Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. Obstet Gynecol 1997; 90:546-552. This manuscript was the first to recognize the strong association between thrombocytopenia in siblings born to a mother with ITP. This observation has now been observed in several reports. Thrombocytopenia in a prior sibling may be the best predictor of thrombocytopenia in an active pregnancy.
31. Burrows RF, Kelton JG. Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynecol 1990; 163:1147-1150.
32. Pradat P, Robert-Gnansia E, Di Tanna GL, et al. First trimester exposure to corticosteroids and oral clefts. Birth Defects Res A Clin Mol Teratol 2003; 67:968-970.
33. Kallen B. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Cleft Palate Craniofac J 2003; 40:624-628.