[Differential diagnosis of thrombocytopenia in pregnancy]

Thrombotic thrombocytopenic purpura with Graves' disease during pregnancy

Thrombotic thrombocytopenic purpura may be seen with several autoimmune disorders such as immune thrombocytopenia purpura, immune hemolytic anemia, and systemic lupus erythematosus, but it is rarely associated with Graves' disease. We report a patient with thrombotic thrombocytopenic purpura associated with Graves' disease.

Report on the management of thrombocytopenia in obstetric patients: A retrospective study

Thrombocytopenia occurs to approximately 8%–10% of pregnant women and this condition is a notable source of morbidity and mortality during pregnancy. In the recent years, our comprehension of thrombocytopenia has progressed on pregnancy. Nevertheless, there has not been adequate information about thrombocytopenia outcomes in obstetric patients. With regard to this topic, we reviewed published reports as an update from the managements on these cases. Nevertheless, recommendations for management of delivery in obstetric women with thrombocytopenia are based on several hypotheses requiring critical analysis. For this cause, we reviewed the management of pregnant patients with thrombocytopenia treated over a period of 37 years.

Some hemostatic parameters in women with obstetric hemorrhage in Sokoto, Nigeria

Obstetric hemorrhage is the leading cause of maternal mortality and morbidity worldwide. This study was carried out to investigate the effect of obstetric hemorrhage on the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count (PLC). Women with obstetric hemorrhage were divided into two categories, women with antepartum hemorrhage (APH) and those with postpartum hemorrhage (PPH). Pregnant women without hemorrhage were included as controls. Eighty-six pregnant women aged 18–45 years (mean age 36.25 ± 10.50 years) were presented to the Obstetrics and Gynaecology Department of Maryam Abacha Women and Children Hospital in Sokoto Metropolis, Sokoto State, Nigeria with history of obstetric hemorrhage. Forty-three age-matched nonhemorrhaging parturient women were included as controls. The determination of PT and APTT was done by manual methods using commercially prepared Diagen reagent kits, whereas PLC was done by manual methods using a hemocytometer. The results of PT and APTT were significantly higher among women with APH (20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) and among women with PPH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds, respectively) compared to normal pregnant women (15.85 ± 0.8930 seconds and 36.225 ± 5.010 seconds, respectively) (P = 0.0001). Similarly, the PLC was significantly higher among normal pregnant women compared to those with APH and PPH (291.425 ± 75.980 × 10⁹ compared to 154.83 ± 47.019 × 10⁹ and 136.43 ± 43.894 × 10⁹, respectively) (P = 0.0001). The PT and APTT of women who presented with PPH were significantly higher compared to those who presented with APH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds versus 20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) (P = 0.02 and P = 0.04, respectively). The PLC was significantly higher among women who presented with APH compared to those who presented with PPH (P = 0.01). The PT and APTT values were higher in the third trimester among women with APH (24.38 ± 2.33 seconds and 52.25 ± 6.71 seconds, respectively), PPH (24.75 ± 2.63 seconds and 58.25 ± 2.53 seconds, respectively), and control women (16.00 ± 0.82 seconds and 34.42 ± 5.59 seconds, respectively) compared to those in first and second trimester. The PLC was significantly lower in the third trimester among APH, PPH, and normal pregnant women (131 ± 23.02 × 10⁹, 99 ± 21.46 × 10⁹, and 192.86 ± 25.44 × 10⁹, respectively). PT and APTT values correlated positively and significantly with trimester (r = 0.52 and 0.65, respectively; P = 0.01). The PLC of women with APH, PPH, and normal control women correlated negatively with trimester (r = −0.36, −0.54, and −0.28, respectively; P = 0.05). Obstetrics hemorrhage compounded the hemostatic status of pregnant women in Sokoto, Nigeria. There is need for the provision of rapid diagnosis of coagulopathy to guide the provision of best therapeutic management options.

Neonatal Immune Thrombocytopenia

BACKGROUND

Neonatal immune thrombocytopenia, a consequence of transplacental transfer of antiplatelet antibodies can result in serious bleeding with disastrous consequences in the otherwise healthy newborn.

METHODS

Over 2 years at a service hospital, 5 mothers with chronic autoimmune thrombocytopenia and one with maternal alloimmunisation delivered, which comprised the study sample.

RESULTS

Of these, two ladies suffered episodes of thrombocytopenia in the current pregnancy. They were provided platelet transfusions and intravenous immunoglobulins. All patients delivered vaginally. Cord blood platelet was normal in all cases. Three babies developed thrombocytopenia, two due to autoimmune and one alloimmune pathology. The nadir of thrombocytopenia occurred in 36-72 hours with recovery taking place in 10 days. The clinical manifestations were petechiae, ecchymosis, gastric bleed and oozing from vitamin K injection site. Two of the affected babies were provided intravenous immunoglobulins and one steroids. Only one of the two mothers who suffered thrombocytopenia during pregnancy and was provided intravenous immunoglobulins was associated with neonatal thrombocytopenia, an inconsistent relation. It was also observed that antenatally provided immunoglobulins raised effectively maternal rather than fetal platelet counts. However, postnatal immunoglobulins were efficacious in thrombocytopenic neonates.

CONCLUSION

Thus inspite of several therapeutic and preventive modalities being described, the optimum management strategy of immune mediated perinatal thrombocytopenia is yet in evolution.