Diagnosis and management of maternal thrombocytopenia in pregnancy

British Journal of Haematology

Volumn 158, Issue 1, 2012, Pages 3-15

  Myers, Bethan ^a,b  

^a LINCOLN COUNTY HOSPITAL   (United Kingdom)

^b NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST   (United Kingdom)

Author keywords

HELLP syndrome; Immune thrombocytopenia; Pregnancy; Thrombocytopenia; Thrombotic thrombocytopenic purpura

Indexed keywords

ACETYLSALICYLIC ACID; AZATHIOPRINE; BLOOD CLOTTING FACTOR 8; CORTICOSTEROID; CYCLOSPORIN A; DANAPAROID; ECULIZUMAB; ELTROMBOPAG; FIBRINOGEN; FONDAPARINUX; IMMUNOGLOBULIN; IMMUNOGLOBULIN G; LEPIRUDIN; LOW MOLECULAR WEIGHT HEPARIN; METHYLPREDNISOLONE; PREDNISOLONE; PROTEIN S; RHESUS D ANTIBODY; RITUXIMAB; ROMIPLOSTIM; TRANEXAMIC ACID; VON WILLEBRAND FACTOR; VON WILLEBRAND FACTOR CLEAVING PROTEINASE;

ANEMIA; ANTIBODY PRODUCTION; ANTIPHOSPHOLIPID SYNDROME; BLEEDING; BONE MARROW DISEASE; BRAIN HEMORRHAGE; CONSERVATIVE TREATMENT; COOMBS TEST; CYANOCOBALAMIN DEFICIENCY; DISEASE SEVERITY; DISSEMINATED INTRAVASCULAR CLOTTING; DRUG EFFICACY; DRUG SAFETY; ENVIRONMENTAL EXPOSURE; EPIDURAL ANESTHESIA; FATTY LIVER; FIBRINOLYSIS; GESTATIONAL THROMBOCYTOPENIA; HELLP SYNDROME; HEMOLYTIC UREMIC SYNDROME; HEPARIN INDUCED THROMBOCYTOPENIA; HUMAN; HYPERSPLENISM; IDIOPATHIC THROMBOCYTOPENIC PURPURA; MAY HEGGLIN ANOMALY; MICROANGIOPATHY; MYELODYSPLASTIC SYNDROME; NEONATAL THROMBOCYTOPENIA; NEWBORN JAUNDICE; PARENT COUNSELING; PERINATAL CARE; PHYSICAL EXAMINATION; POSTPARTUM HEMORRHAGE; PREECLAMPSIA; PREGNANCY; PRENATAL CARE; PRIORITY JOURNAL; PROTEIN BLOOD LEVEL; REGIONAL ANESTHESIA; REVIEW; SIDE EFFECT; SPLENECTOMY; THROMBOCYTE COUNT; THROMBOCYTE FUNCTION; THROMBOCYTE TRANSFUSION; THROMBOCYTOPENIA; THROMBOSIS PREVENTION; THROMBOTIC THROMBOCYTOPENIC PURPURA; TROPHOBLAST; VENOUS THROMBOEMBOLISM; VON WILLEBRAND DISEASE;

EID: 85027946907     PISSN: 00071048     EISSN: 13652141     Source Type: Journal    
DOI: 10.1111/j.1365-2141.2012.09135.x     Document Type: Review

References (92)

1. Abbassi-Ghanavati, M., Greer, L.G. & Cunningham, F.G. (2006) Pregnancy and laboratory administrative data, a reference table for clinicians. Obstetrics & Gynecology, 114, 1326-1331.
2. ACOG Committee on Practice Bulletins-Obstetrics (2002) ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstetrics & Gynecology, 99, 159-167.
3. Baili, L., Khellaf, M., Languille, L., Bieling, P., Godeau, B. & Michel, M. (2009) Impact of pregnancy on the course of thrombocytopenic purpura: an observational study on 44 cases. Blood, 114, 1320.
4. Ballin, A., Andrew, M., Ling, E., Perlman, M. & Blanchette, V. (1988) High-dose intravenous gammaglobulin therapy for neonatal autoimmune thrombocytopenia. Journal of Pediatrics, 112, 789-792.
5. Belkin, A., Levy, A. & Sheiner, E. (2009) Perinatal outcomes and complications of pregnancy in women with immune thrombocytopenic purpura. Journal of Maternal-Fetal & Neonatal Medicine, 22/11, 1081-1085.
6. BMJ Publishing Group Ltd and RPS Publishing British National Formulary. online Sept 2011: accessed via.
7. Bobbio-Pallavicini, E., Gugliotta, L., Centurioni, R., Porta, C., Vianelli, N., Billio, A., Tacconi, F. & Ascari, E. (1997) Antiplatelet agents in thrombotic thrombocytopenic purpura (TTP). Results of a randomized multicenter trial by the Italian Cooperative Group for TTP. Haematologica, 82, 429-435.
8. Boehlen, F., Hohlfeld, H., Extermann, P., Perneger, T. & de Moerloose, P. (2000) Platelet count at term pregnancy: a reappraisal of the threshold. Obstetrics and Gynecology, 95, 30.
9. Burrows, R.F. & Kelton, J.G. (1990) Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. American Journal of Obstetrics and Gynecology, 162, 732-734.
10. Calderwood, C. (2006) Thromboembolism and thrombophilia in pregnancy. Current Obstetrics & Gynaecology, 16, 321-326.
11. Celik, C., Gezginç, K., Altintepe, L., Tonbul, H.Z., Yaman, S.T., Akyürek, C. & Türk, S. (2003) Results of the pregnancies with HELLP syndrome. Renal Failure, 25, 613-618.
12. Chakravarty, E., Murray, E., Kelman, A. & Farmer, P. (2011) Pregnancy outcomes following maternal exposure to rituximab. Blood, 117, 1499-1506.
13. Christiaens, G.C., Nieuwenhuis, H.K., von dem Borne, A.E., Ouwehand, W.H., Helmerhorst, F.M., van Dalen, C.M. & van der Tweel, I. (1990) Idiopathic thrombocytopenic purpura in pregnancy: a randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count. British Journal of Obstetrics & Gynaecology, 97, 893-898.
14. Christiaens, G.C., Niewenhuis, H.K. & Bussel, J.B. (1997) Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. Obstetrics and Gynecology, 90, 546-552.
15. Cines, D.B. & Bussel, J.B. (2005) How I treat idiopathic thrombocytopenic purpura (ITP). Blood, 106, 2244-2251.
16. Ciurzynski, M., Jankowski, K., Pietrzak, B., Mazanowska, N., Rzewuska, E., Kowalik, R. & Pruszczyk, P. (2011) Use of fondaparinux in a pregnant woman with pulmonary embolism and heparin-induced thrombocytopenia. Medical Science Monitor, 17, CS56-59.
17. Cleary, B.J. & Kallen, B. (2009) Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Research. Part A. Clinical and Molecular Teratology, 85, 647-654.
18. Dashe, J.S., Ramin, S.M. & Cunningham, F.G. (1998) The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstetrics & Gynecology, 91(5 Pt 1), 662-668.
19. Douglas, M.J. (2005) The use of neuraxial anesthesia in parturients with thrombocytopenia: what is an adequate platelet count? Evidence-Based Obstetric Anesthesia. Blackwell, Malden, MA.
20. Ducloy-Bouthors, A.S., Caron, C., Subtil, D., Provot, F., Tournoys, A., Wibau, B. & Krivosic-Horber, R. (2003) Thrombotic thrombocytopenic purpura: medical and biological monitoring of six pregnancies. European Journal of Obstetrics, Gynecology and Reproductive Biology, 111, 146-152.
21. Erkman, J. & Blythe, J.G. (1972) Azathioprine therapy complicated by pregnancy. Obstetrics & Gynecology, 40, 708-710.
22. Fakhouri, F., Jablonski, M., Lepercq, J., Blouin, J., Benachi, A., Hourmant, M., Pirson, Y., Dürrbach, A., Grünfeld, J.P., Knebelmann, B. & Frémeaux-Bacchi, V. (2008) Factor H, membrane cofactor protein, and factor I mutations in patients with haemolysis, elevated liver enzymes, and low platelet syndrome. Blood, 112, 4542-4545.
23. Fakhouri, F., Roumenina, L., Provot, F., Sallee, S., Caillard, L., Couzi, M., Essig, M., Ribes, D., Dragon-Durey, M.A., Bridoux, F., Rondeau, E. & Fremeaux-Bacchi, V. (2010) Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. Journal of the American Society of Nephrology, 21, 859-867.
24. Fay, R.A., Hughes, A.O. & Farron, N.T. (1983) Platelets in pregnancy: hyperdestruction in pregnancy. Obstetrics & Gynecology, 61, 238.
25. Fujimura, K., Harada, Y., Fujimoto, T., Kuramoto, A., Ikeda, Y., Akatsuka, J., Dan, K., Omine, M. & Mizoguchi, H. (2002) Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. International Journal of Haematology, 75, 426-433.
26. Fujita, A., Sakai, R., Matsuura, S., Yamamoto, W., Ohshima, R., Kuwabara, H., Okuda, M., Takahashi, T., Ishigatsubo, Y. & Fujisawa, S. (2010) A retrospective analysis of obstetric patients with idiopathic thrombocytopenic purpura: a single center study. International Journal of Haematology, 92, 463-467.
27. Gall, B., Yee, A., Berry, B., Birchman, D., Hayashi, A., Dansereau, J. & Hart, J. (2010) Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura. Journal of Obstetrics and Gynaecology Canada, 32, 1167-1171.
28. Garcia, S., Merino, J.L., Rodríguez, M., Velasco, A. & Moreno, M.C. (1991) Pseudo-thrombocytopenia: incidence, causes and methods of detection. Sangre, 36, 197-200.
29. Gasim, T. (2011) Immune thrombocytopenia in pregnancy: a reappraisal of obstetric management and outcome. Journal of Reproductive Medicine, 56, 163-168.
30. Gerhardt, A., Scharf, R.E. & Zotz, R.B. (2009) Successful use of danaparoid in two pregnant women with heart valve prosthesis and heparin-induced thrombocytopenia Type II (HIT). Clinical & Applied Thrombosis/Hemostasis, 15, 461-464.
31. Gill, K.K. & Kelton, J.G. (2000) Management of idiopathic thrombocytopenic purpura in pregnancy. Seminars in Haematology, 37, 275-289.
32. Gisbert, J.P. (2010) Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflammatory. Bowel Disease, 16, 881-895.
33. Greenbaum, L., Babu, S., Furman, R.R., Sheerin, N., Cohen, D., Gaber, O., Eitner, F., Delmas, Y., Loirat, C., Bedrosian, C.L. & Legendre, C. (2011) Eculizumab is an effective long-term treatment in patients with atypical hemolytic uremic syndrome (aHUS) resistant to plasma exchange/infusion (PE/PI): results of an extension study. Blood, 118, 193.
34. Greer, I.A. & Nelson-Piercy, C. (2005) Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism. Blood, 106, 401-407.
35. Harenberg, J., Jorg, I., Bayerl, C. & Fiehn, C. (2005) Treatment of a woman with lupus pernio, thrombosis and cutaneous intolerance to heparin using lepirudin during pregnancy. Lupus, 14, 411-412.
36. Hovinga, J.A. & Meyer, S.C. (2008) Current management of thrombotic thrombocytopenic purpura. Current Opinion in Hematology, 15, 445-450.
37. Jensen, J.F., Wiedmeier, S.E., Henry, E., Silver, R.M. & Christensen, R.D. (2011) Linking maternal platelet counts with neonatal platelet counts and outcomes using the data repositories of a multihospital health care system. American Journal of Perinatology, 28, 597-604.
38. Joint Formulary Committee (2011) British National Formulary, No 62 (September 2011) 14.4 Vaccines and Antisera. Pharmaceutical Press, London.
39. Kelly, R., Arnold, L., Richards, S., Hill, A., Bomken, C., Hanley, J., Loughney, A., Beauchamp, J., Khursigara, G., Rother, R.P., Chalmers, E., Fyfe, A., Fitzsimons, E., Nakamura, R., Gaya, A., Risitano, A.M., Schubert, J., Norfolk, D., Simpson, N. & Hillmen, P. (2010) The management of pregnancy in paroxysmal nocturnal haemoglobinuria on long term eculizumab. British Journal of Haematology, 149, 446-450.
40. Kirkpatrick, C.A. (2010) The HELLP syndrome. Acta Clinica, 65, 91-97.
41. Klink, D.T., van Elburg, R.M., Schreurs, M.W. & van Well, G.T. (2008) Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clinical Developments in Immunology, 2008, 271363.
42. Knight, M., Nelson-Piercy, C., Kurinczuk, J.J., Spark, P. & Brocklehurst, P. (2008) UK Obstetric Surveillance System A prospective national study of acute fatty liver of pregnancy in the UK. Gut, 57, 951.
43. Koyama, S., Tomimatsu, T., Kanagawa, T., Kumasawa, K., Tsutsui, T. & Kimura, T. (2012) Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. American Journal of Hematology, 87, 15-21.
44. Lee, D.H. & Warkentin, T.E. (2007) Frequency of heparin-induced thrombocytopenia. In: Heparin-Induced Thrombocytopenia, 4th edn (ed. by T.E. Warkentin & A. Greinacher), pp. 67-116. Informa Healthcare USA, New York, NY.
45. Letsky, E.A. & Greaves, M. (1996) Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology. British Journal of Haematology, 95, 21-26.
46. Lindoff, C., Rybo, G. & Astedt, B. (1993) Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications. Thrombosis & Haemostasis, 70, 238-240.
47. Maynard, S.E., Venkatesha, S., Thadhani, R. & Karumanchi, S.A. (2005) Soluble Fms-like tyrosine kinase 1 and endothelial dysfunction in the pathogenesis of pre-eclampsia. Pediatric Research, 57, 1R-7R.
48. McCrae, K.R. (2006) Thrombocytopenia in pregnancy. In: Platelets (ed. by A.D. Michelson), pp. 925-933. Elsevier, New York, NY.
49. McCrae, K.R. (2010) Thrombocytopenia in pregnancy. ASH Education Book, vol 2010 (1) 397-402; doi: 10.1182/asheducation-2010.1.397.
50. McCrae, K.R. & Cines, D.B. (1997) Thrombotic microangiopathy in pregnancy. Seminars in Hematology, 34, 148-158.
51. McCrae, K.R., Samuels, P. & Schreiber, A.D. (1992) Pregnancy-associated thrombocytopenia: pathogenesis and management. Blood, 80, 2697-2714.
52. Michel, M., Novoa, M.V. & Bussel, J.B. (2003) Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. British Journal of Haematology, 123, 142-146.
53. Mirza, F.G. & Cleary, K.L. (2009) Pre-eclampsia and the kidney. Seminars in Perinatology, 33, 173-178.
54. Myatt, L. & Webster, R.P. (2009) Vascular biology of pre-eclampsia. Thrombosis & Haemostasis, 7, 375-384.
55. Myers, B. (2009) Thrombocytopenia in pregnancy. The Obstetrician and Gynaecologist, 11, 177-183.
56. Myers, B. & Pavord, S. (2011) Diagnosis and management of antiphospholipid syndrome in pregnancy. The Obstetrician and Gynaecologist, 13, 15-21.
57. Myers, B., Westby, J. & Strong, J. (2003) Prophylactic use of danaparoid in high-risk pregnancy with heparin-induced thrombocytopenia positive skin reaction. Blood Coagulation & Fibrinolysis, 14, 485-487.
58. Neylon, A.J., Saunders, P.W., Howard, M.R., Proctor, S.J. & Taylor, P.R. (2003) Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. British Journal of Haematology, 122, 966-974.
59. Nurnberger, J., Philipp, T., Witzke, O., Saez, O., Vester, U., Baba, H. & Kribben, A. (2009) Eculizumab for atypical hemolytic-uremic syndrome. New England Journal of Medicine, 360, 542-544.
60. Ostensen, M., Khamashta, M., Lockshin, M., Parke, A., Brucato, A., Carp, H., Doria, A., Rai, R., Meroni, P., Cetin, I., Derksen, R., Branch, W., Motta, M., Gordon, C., Ruiz-Irastorza, G., Spinillo, A., Friedman, D., Cimaz, R., Czeizel, A., Piette, J., Cervera, R., Levy, R., Clement, M., De Carolis, S., Petri, M., Shoenfeld, Y., Faden, D., Valesini, G. & Tincani, A. (2006) Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Research & Therapy, 8, 209.
61. Ozkan, H., Cetinkaya, M., Koksal, N., Ali, R., Gunes, A.M., Baytan, B., Ozkalemkas, F., Ozkocaman, V., Ozcelik, T., Gunay, U., Tunali, A., Kimya, Y. & Cengiz, C. (2010) Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. Journal of Perinatology, 30, 38-44.
62. Pavord, S. (2010) Inherited disorders of primary hemostasis. In: The Obstetric Hematology Manual, Ch 14 (ed. by S. Pavord & S. Hunt), pp. 176-185. Cambridge University Press, Cambridge, UK.
63. Payne, S.D., Resnik, R., Moore, T.R., Hedriana, H.L. & Kelly, T.F. (1997) Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia. American Journal of Obstetrics and Gynecology, 177, 149-155.
64. Peitsidis, P. & Kadir, R. (2011) Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opinion on Pharmacotherapy, 12, 503-516.
65. Price, H.V., Salaman, J.R., Laurence, K.M. & Langmaid, H. (1976) Immunosuppressive drugs and the foetus. Transplantation, 21, 294-298.
66. Provan, D., Stasi, R., Newland, A., Blanchette, V.S., Bolton-Maggs, P., Bussel, J.B., Chong, B., Cines, D., Gernsheimer, T., Godeau, B., Grainger, J., Greer, I., Hunt, B., Imbach, P., Lyons, G., McMillan, R., Rodeghiero, F., Sanz, M., Tarantino, M., Watson, S., Young, J. & Kuter, D. (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood, 115, 168-186.
67. Reddy, D., Murphy, S.J., Kane, S.V., Present, D.H. & Kornbluth, A.A. (2008) Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. The American Journal of Gastroenterology, 103, 1203-1209.
68. Reindl, W., Schmid, R.M. & Huber, W. (2007) Cyclosporin A treatment of steroid-refractory ulcerative colitis during pregnancy: report of two cases. Gut, 56, 1019.
69. Sadler, J.E. (2008) Von Willebrand factor, ADAMTS13 and thrombotic thrombocytopenic purpura. Blood, 112, 11-18.
70. Samuels, P., Bussel, J.B., Braitman, L.E., Tomaski, A., Druzin, M.L., Mennutti, M.T. & Cines, D. (1990) Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura. New England Journal of Medicine, 323, 229-235.
71. Sanchez-Luceros, A., Farias, C.E., Amaral, M.M., Kempfer, A.C., Votta, R., Marchese, C., Salviu, M., Woods, A., Meschengieser, S.S. & Lazzari, M.A. (2004) von Willebrand factor-cleaving protease (ADAMTS13) activity in normal non-pregnant women, pregnant and post delivery women. Thrombosis and Haemostasis, 92, 1320-1326.
72. Schmid, J., Piroth, D., Buhrlen, M., Maass, N., Brummendorf, T.H. & Galm, O. (2011) Successful rituximab treatment of refractory immune thrombocytopenia during pregnancy. Onkologie, 34(Suppl 6), p240, 0378-584X.
73. Scioscia, A.L., Grannum, P.A., Copel, J.A. & Hobbins, J.C. (1988) The use of percutaneous umbilical blood sampling in immune thrombocytopenic purpura. American Journal of Obstetrics and Gynecology, 159, 1066-1068.
74. Scully, M., Starke, R., Lee, R., Mackie, I., Machin, S. & Cohen, H. (2006) Successful management of pregnancy in women with a history of thrombotic thrombocytopenic purpura. Blood Coagulation & Fibrinolysis, 17, 459-463.
75. Scully, M., Yarranton, H., Liesner, R., Cavenagh, J., Hunt, B., Benjamin, S., Bevan, D., Mackie, I. & Machin, S. (2008) Regional UK TTP registry: correlation with laboratory ADAMTS 13 analysis and clinical features. British Journal of Haematology, 142, 819-826.
76. Scully, M., Hunt, B.J., Benjamin, S., Liesner, R., Rose, P., Peyvandi, F., Cheung, B. & Machin, S.J., on behalf of British Committee for Standards in Haematology (2012). Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. British Journal of Haematology, in press.
77. Segal, J.B. & Powe, N.R. (2006) Prevalence of immune thrombocytopenia: analyses of administrative data. Journal of Thrombosis & Haemostasis, 4, 237-283.
78. Severinsen, M.T., Engebjerg, M.C. & Farkas, D.K. (2011) Risk of venous thromboembolism in patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study. British Journal of Haematology, 152, 360-362.
79. Sibai, B.M. & Ramadan, M.K. (1993). Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. American Journal of Obstetrics & Gynecology, 168(6 Pt 1), 1682-1687; discussion 1687-90.
80. Sibai, B.M., Ramadan, M.K., Usta, I., Salama, M., Mercer, B.M. & Friedman, S.A. (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). American Journal of Obstetrics & Gynecology, 169, 1000-1006.
81. Smyth, B. (2011) Spontaneous hepatic rupture associated with HELLP syndrome. Journal of Diagnostic Ultrasonography, 27, 37-39.
82. Sunoda, T., Ohkuchi, A., Izumi, A., Watanabe, T., Matsubara, S. & Sato, I. (2002) Minakami twin pregnancies than in singleton pregnancies. Acta Obstetrics & Gynecology Scandanavia, 81, 840.
83. Taylor, C.M., Machin, S.J., Wigmore, S., Goodship, T.H.J. & on behalf of a working party from the Renal Association, The British Committee for Standards in Haematology and the British Transplantation Society (2010) Clinical Practice Guidelines for the management of atypical Haemolytic Uraemic Syndrome in the United Kingdom. British Journal of Haematology, 148, 37-47.
84. van Veen, J.J., Nokes, T.J. & Makris, M. (2010) The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. British Journal of Haematology, 148, 15-25.
85. Venkatesha, S., Toporsian, M., Lam, C., Hanai, J., Mammoto, T. & Kim, Y. (2006) Soluble endoglin contributes to the pathogenesis of pre-eclampsia. Nature Medicine, 12, 642-649.
86. Verdy, E., Bessous, V., Dreyfus, M., Kaplan, C., Tchernia, G. & Uzan, S. (1997) Longitudinal analysis of platelet count and volume in normal pregnancy. Thrombosis and Haemostasis, 77, 806-807.
87. Vesely, S.K., Li, X., McMinn, J.R., Terrell, D.R. & George, J.N. (2004) Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Transfusion, 44, 1149-1158.
88. Warkentin, T., Greinacher, A., Koster, A. & Lincoff, A. (2008) Treatment and prevention of heparin-induced thrombocytopenia: American College of chest physicians evidence-based clinical practice guidelines (8th Edition). Chest, 133(6 Suppl), 340S-380S.
89. Webert, K.E., Mittal, R., Sigouin, C., Heddle, N.M. & Kelton, J.G. (2003) A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood, 102, 4306-4311.
90. Win, N., Rowley, M., Pollard, C., Beard, J., Hambley, H. & Booker, M. (2005) Severe gestational (incidental) thrombocytopenia: to treat or not to treat. Haematology, 10, 69-72.
91. Yarranton, H., Cohen, H., Pavord, S.R., Benjamin, S., Hagger, D. & Machin, S.J. (2003) Venous thromboembolism associated with the management of acute thrombotic thrombocytopenic purpura. British Journal of Haematology, 121, 778-785.
92. Zarrinpar, A., Farmer, D.G., Ghobrial, R.M., Lipshutz, G.S., Gu, Y., Hiatt, J.R. & Busuttil, R.W. (2007) Liver transplantation for HELLP syndrome. American Journal of Surgery, 73, 1013-1016.