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Borhany M, Abid M, Zafar S, Zaidi U, Munzir S, Shamsi T. Thrombocytopenia in Pregnancy: Identification and Management at a Reference Center in Pakistan. Cureus 2022; 14:e23490. [PMID: 35475097 PMCID: PMC9035312 DOI: 10.7759/cureus.23490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: The study aimed to evaluate the causes of thrombocytopenia in pregnancy and its management along with the outcome in the COVID-19 era. Methods: Recruitment for this prospective, cross-sectional observational study of thrombocytopenia in pregnancy (platelet counts <100x109/L) was done from January 2017 to August 2020 at the National Institute of Blood Diseases (NIBD) after taking the patients’ informed consent. Complete clinical and lab profile of patients was also collected. Results: A total of 150 pregnant women with thrombocytopenia were enrolled, with the mean age being 27.3±4.64 years. Mean platelet counts at baseline were 48.0±24. Main clinical manifestations at baseline included: anemia 65.9%, bruises 23.25%, and edema 9.3%. Causes of thrombocytopenia were gestational thrombocytopenia (GT) 72 (48%), acute fatty liver five (3.3%), pre-eclampsia in 11 (7.3%), and eclampsia seven (4.6%). Causes not specific to pregnancy included 30 (20%) cases of ITP, hepatitis C, and nutritional deficiency was reported in nine (6%) patients each. 72/150 received supportive care treatment to manage thrombocytopenia and were closely monitored and given supplements. Twenty (66.6%) ITP patients received treatment with steroids, with complete response in 70% of them seen. Overall, 38 (25.3%) women with bleeding symptoms and platelet count <50x109/L received platelet transfusions. Conclusion: The study shows that pre-eclampsia and eclampsia are serious conditions with a high risk for complications, while GT is a benign and the most common cause of thrombocytopenia in pregnancy which requires no active treatment. The other causes such as ITP and infections require individualized management.
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2
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Cooper N, Bird R, Chinthammitr Y, George B, Stentoft J, Tomiyama Y, Zaja F, Hokland P. How I treat immune thrombocytopenia - a global view. Br J Haematol 2021; 193:1076-1086. [PMID: 33570179 DOI: 10.1111/bjh.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Nichola Cooper
- Department of Haematology. Division of Immunology and Inflammation, Imperial College London, London, UK
| | - Robert Bird
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Yingyong Chinthammitr
- Department of Medicine, Division of Hematology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Jesper Stentoft
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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3
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Eslick R, Cutts B, Merriman E, McLintock C, McDonnell N, Shand A, Clarke L, Ng S, Kando I, Curnow J. HOW Collaborative position paper on the management of thrombocytopenia in pregnancy. Aust N Z J Obstet Gynaecol 2021; 61:195-204. [PMID: 33438201 DOI: 10.1111/ajo.13303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022]
Abstract
Thrombocytopenia in pregnancy is a common occurrence, affecting up to 10% of women by the time of birth. These recommendations aim to provide pragmatic guidance on the investigation, diagnosis and management of thrombocytopenia in pregnancy; including safety of neuraxial anaesthesia and precautions required for birth. Management of neonatal thrombocytopenia is also addressed. The authors are clinicians representing haematology, obstetric medicine, maternal-fetal medicine, and anaesthesia. Each author conducted a detailed literature review then worked collaboratively to produce a series of unanimous recommendations. The recommendation strength is limited by the lack of high-quality clinical trial data, and represents level C evidence.
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Affiliation(s)
- Renee Eslick
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Briony Cutts
- Royal Women's Hospital, Melbourne, Victoria, Australia.,Joan Kirner Women's and Children's at Sunshine Hospital, Melbourne, Victoria, Australia
| | | | | | - Nolan McDonnell
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Antonia Shand
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lisa Clarke
- Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Sara Ng
- Southern Highlands Haematology, Sydney, New South Wales, Australia
| | - Ian Kando
- National Women's Hospital, Auckland, New Zealand
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Porcelijn L, Schmidt DE, Oldert G, Hofstede-van Egmond S, Kapur R, Zwaginga JJ, de Haas M. Evolution and Utility of Antiplatelet Autoantibody Testing in Patients with Immune Thrombocytopenia. Transfus Med Rev 2020; 34:258-269. [PMID: 33046350 DOI: 10.1016/j.tmrv.2020.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023]
Abstract
To this day, immune thrombocytopenia (ITP) remains a clinical diagnosis made by exclusion of other causes for thrombocytopenia. Reliable detection of platelet autoantibodies would support the clinical diagnosis, but the lack of specificity and sensitivity of the available methods for platelet autoantibody testing limits their value in the diagnostic workup of thrombocytopenia. The introduction of methods for glycoprotein-specific autoantibody detection has improved the specificity of testing and is acceptable for ruling in ITP but not ruling it out as a diagnosis. The sensitivity of these assays varies widely, even between studies using comparable assays. A review of the relevant literature combined with our own laboratory's experience of testing large number of serum and platelet samples makes it clear that this variation can be explained by variations in the characteristics of the tests, including in the glycoprotein-specific monoclonal antibodies, the glycoproteins that are tested, the platelet numbers used in the assay and the cutoff levels for positive and negative results, as well as differences in the tested patient populations. In our opinion, further standardization and optimization of the direct autoantibody detection methods to increase sensitivity without compromising specificity seem possible but will still likely be insufficient to distinguish the often very weak specific autoantibody signals from background signals. Further developments of autoantibody detection methods will therefore be necessary to increase sensitivity to a level acceptable to provide laboratory confirmation of a diagnosis of ITP.
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Affiliation(s)
- Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.
| | - David E Schmidt
- Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gonda Oldert
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | | | - Rick Kapur
- Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Jan Zwaginga
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands; Sanquin Research, Center for Clinical Transfusion Research, Leiden, the Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands; Sanquin Research, Center for Clinical Transfusion Research, Leiden, the Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
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5
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Zitiello A, Grant GE, Ben Ali N, Feki A. Thrombocytopaenia in pregnancy: the importance of differential diagnosis during the COVID-19 pandemic. J Matern Fetal Neonatal Med 2020; 35:2414-2416. [PMID: 32643469 DOI: 10.1080/14767058.2020.1786527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Since the beginning of the COVID-19 pandemic, an optimal management of vulnerable patients, such as pregnant women, has been regarded as a challenge for healthcare professionals. Although thrombocytopaenia is considered a minor criterion for admission within an intensive care unit, a low platelet count has been observed in COVID-19 patients, including a pregnant woman, who developed severe pulmonary complications. Furthermore, thrombocytopaenia has been proposed as a potential biomarker in order to identify cases at high-risk complications. Nevertheless, thrombocytopaenia is a relatively frequent condition observed in pregnancy. In this context, a differential diagnosis is essential for the correct management of COVID-19 pregnant women.
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Affiliation(s)
- A Zitiello
- Department of Gynaecology and Obstetrics and Operative Surgery, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - G E Grant
- Department of Gynaecology and Obstetrics and Operative Surgery, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - N Ben Ali
- Department of Gynaecology and Obstetrics and Operative Surgery, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - A Feki
- Department of Gynaecology and Obstetrics and Operative Surgery, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
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6
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Yardimci I, Tunc M, Say B, Sayan CD, Biligi MYK, Yalcin S, Coskun O. A Case Report: Isolated Pontine Lesion in Hypertensive of a Pregnant Patient with Idiopathic Thrombocytopenia. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/19-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic diagnosis characterised by headache, seizures, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. PRES manifestation is a situation of medical emergency; however, it is a fully reversible condition, especially when diagnosed and treated immediately. The main problem lies in the impairment of cerebral blood flow autoregulation which, in turn, leads to endothelial dysfunction and vasogenic brain oedema. MRI indicates cerebral oedema in the occipital, temporal, and parietal lobes. Brainstem involvement is very rare in the literature. Idiopathic thrombocytopenia-related PRES is also rare in the literature. In this article, a case of PRES with only pons involvement in MRI after hypertensive attack in a pregnant patient with idiopathic thrombocytopenia is presented. PRES may present only brainstem involvement, as seen in this present case. Whether or not mild hypertension and mild thrombocytopenia found in this case are associated with limited disease should be evaluated. Prolonged spreading depression may have a role in the pathophysiology of PRES.
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Affiliation(s)
- Ilknur Yardimci
- Department of Neurology, Kırıkkale University, Kırıkkale, Turkey
| | - Mehmet Tunc
- Department of Neurology, Kırıkkale University, Kırıkkale, Turkey
| | - Bahar Say
- Department of Neurology, Kırıkkale University, Kırıkkale, Turkey
| | | | | | - Selim Yalcin
- Department of Hematology Oncology, Kırıkkale University, Kırıkkale, Turkey
| | - Ozlem Coskun
- Department of Neurology, Kırıkkale University, Kırıkkale, Turkey
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7
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Rodeghiero F, Marranconi E. Management of immune thrombocytopenia in women: current standards and special considerations. Expert Rev Hematol 2020; 13:175-185. [PMID: 31903814 DOI: 10.1080/17474086.2020.1711729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder, with an incidence rate of 20-40/million adults/year and an estimated prevalence in women of childbearing age of 24.5/million.Areas covered: Authors discuss management of ITP in pregnancy, treatment-related toxicity, delivery, neonatal thrombocytopenia and breastfeeding, and other women's specific issues. The search of papers published between January 1990 and December 2019 was done on PubMed using combinations of the keywords below. The distinction between ITP and other thrombocytopenias in pregnancy is of paramount importance. The current belief (at variance with the past) that ITP is a relatively benign disease pregnancy is emphasized.Expert opinion: The lack of randomized, prospective, controlled studies hampers evidence-based statements. Remarkably, ITP diagnosis is still one of exclusion, there are no clinical or laboratory criteria for prognosis and we still need more solid data on the risks related to neonatal thrombocytopenia. Corticosteroids and IVIG remain the mainstay of treatment, since rituximab, thrombopoietin-receptor agonists, fostamatinib may be toxic in pregnancy. Safety and efficacy of recombinant-human-thrombopoietin, available in China, require confirmation studies. Quality of life and women-related toxicity of treatments in young girls, adults, and elders are still an orphan area of investigation.
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Affiliation(s)
- Francesco Rodeghiero
- Hematology Project Foundation and Department of Hematology, S. Bortolo Hospital, Vicenza, Italy
| | - Ettore Marranconi
- Hematology Project Foundation and Department of Hematology, S. Bortolo Hospital, Vicenza, Italy.,Graduate School in Hospital Pharmacy, Pisa University, Pisa, Italy
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8
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Xu X, Zhang Y, Yu X, Huang Y. Preoperative moderate thrombocytopenia is not associated with increased blood loss for low-risk cesarean section: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:269. [PMID: 31357932 PMCID: PMC6664719 DOI: 10.1186/s12884-019-2417-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The occurrence of thrombocytopenia is as high as 7-12% in pregnancy, yet minimum platelet count safe for cesarean section remains unknown. METHODS In this retrospective noninferior cohort study, we consecutively included patients undergoing cesarean section for a period of 6 years in a tertiary hospital and excluded patients at very high risk for excessive hemorrhage. The included patients with preoperative platelet count of 50-100 × 109/L were defined as the thrombocytopenic group. The control group were eligible patients with preoperative platelet count>150 × 109/L, matched to the thrombocytopenic group by age and operation timing in a 1:2 ratio. Mixed effect model was used to analyze the effect of thrombocytopenia based on a noninferiority assumption. The predefined noninferiority delta of bleeding was 50 mL. RESULTS There was no significant difference of the calculated blood loss between the thrombocytopenic and the control group (mean difference = 8.94, 95% CI - 28.34 mL to 46.09 mL). No statistical difference was observed in the requirement for blood transfusion, visually estimated blood loss, or the incidence of adverse events between groups. Although there were more patients admitted to intensive care unit (odds ratio = 12, 95% CI 2.69-53.62, p = 0.001) in the thrombocytopenic group, most of them required critical care for reasons other than hemorrhage. The thrombocytopenic group had longer length of hospital stay (mean difference = 0.40 days, 95% CI 0.09-0.71, p = 0.011), but the difference was considered as clinically insignificant. CONCLUSIONS Preoperative moderate thrombocytopenia is not associated with increased blood loss, blood transfusion, or occurrence of adverse events in patients undergoing cesarean section in absence of additional bleeding risk.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yuelun Zhang
- Central Research Laboratory, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xuerong Yu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China
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9
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Clinical characteristics, neonatal risk and recurrence rate of gestational thrombocytopenia with platelet count <100 × 10 9/L. Eur J Obstet Gynecol Reprod Biol 2018; 231:75-79. [PMID: 30340119 DOI: 10.1016/j.ejogrb.2018.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in pregnancy. In most cases of GT, thrombocytopenia is mild (100-150 × 109/L) and has no consequences for either the mother or the fetus. We aimed to investigate the characteristics, neonatal risk and recurrence rate of GT with a platelet count <100 × 109/L. STUDY DESIGN We reviewed the records of women who delivered during 2006-2016 at a large tertiary care university hospital, and who had platelet count <100 × 109/L during pregnancy. RESULTS Of 97 pregnancies in which platelet count lower than 100 × 109/L was encountered, 66 (68%) were diagnosed as GT and 31 (32%) as new-onset immune-thrombocytopenic purpura (ITP). The proportions of women with onset of thrombocytopenia in early pregnancy (P = 0.004) and a lower maternal nadir platelet count (P = 0.01) were higher among those with new-onset ITP than GT. There was no difference in the rate of neonatal thrombocytopenia (<100 × 109/L) between those with newly diagnosed ITP and GT (16.1% vs. 10.6%, P = 0.51). Among women with GT, the rate of neonatal thrombocytopenia was higher in those who experienced antepartum bleeding (P = 0.009) and in whom the onset of thrombocytopenia was in early pregnancy (P = 0.002). Of 40 subsequent pregnancies, a recurrence of GT (<100 × 109/L) was encountered in 22 (55%), with similar maternal and perinatal outcomes compared to the initial pregnancy. CONCLUSION The risk of neonatal thrombocytopenia was substantial, with no difference found between those with GT and new-onset ITP. The recurrence rate of GT was high in subsequent pregnancies.
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10
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Fogerty AE. Thrombocytopenia in Pregnancy: Mechanisms and Management. Transfus Med Rev 2018; 32:225-229. [PMID: 30177431 DOI: 10.1016/j.tmrv.2018.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 11/24/2022]
Abstract
Thrombocytopenia is a common hematologic issue encountered by obstetricians and hematologists, detected in about 10% of all pregnancies. In the vast majority of cases, the thrombocytopenia will be attributed to gestational thrombocytopenia (GT), where the thrombocytopenia is mild, does not necessitate active management, and does not introduce maternal or fetal bleeding risk. Although GT is common, the specific mechanism responsible for it is not known with certainty, and therefore, differentiating it from other causes of thrombocytopenia can be challenging. Previously proposed explanations for GT suggest that a decrease in platelet count is universal in pregnancy, and women diagnosed with GT are simply those with a baseline platelet count on the lower end of normal range. This concept is challenged in this review, and a possible mechanism for GT is proposed. Additionally, a framework for approaching the diagnosis and management of thrombocytopenia in pregnancy is presented.
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Affiliation(s)
- Annemarie E Fogerty
- Department of Medicine: Hematology/Oncology, Massachusetts General Hospital, Boston, MA.
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11
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Wang X, Xu Y, Luo W, Feng H, Luo Y, Wang Y, Liao H. Thrombocytopenia in pregnancy with different diagnoses: Differential clinical features, treatments, and outcomes. Medicine (Baltimore) 2017; 96:e7561. [PMID: 28723784 PMCID: PMC5521924 DOI: 10.1097/md.0000000000007561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the clinical features and perinatal treatment of thrombocytopenia induced by different causes during pregnancy.Clinical data from 195 pregnant women with thrombocytopenia attending 2 tertiary hospitals from January 2014 to October 2016 were retrospectively studied. The obtained data were analyzed with SPSS 19.0 software.There were 117 (60.0%), 55 (28.2%), and 23 cases (11.8%) of pregnancy-associated thrombocytopenia (PAT), idiopathic thrombocytopenia (ITP), and hypertensive disorder in pregnancy (PIH), respectively. The percentage of nulliparous women, gestational age at delivery, date of diagnosis of thrombocytopenia, and delivery mode significantly differed between the patients in these 3 groups (P < .05). Patients with PIH had a higher percentage of premature delivery and of lower birth weight infants than patients in the other 2 groups. The 3 groups had similar incidences of postpartum hemorrhage, rates of stillbirth, and neonatal Apgar scores at 5 minutes. PAT and PIH patients had different platelet counts after delivery compared with at diagnosis, whereas the platelet counts of the ITP patients were similar at diagnosis and after delivery. ITP patients in the nontreatment group and the treatment group had significantly different platelet counts (P < .05), and in the treatment group, the maternal platelet count did not differ for treatment with intravenous immunoglobulin (IVIg) versus corticosteroids.The causes of thrombocytopenia in pregnancy are diverse, and the clinical features vary widely. Timely analysis is needed to determine the primary cause of thrombocytopenia, and appropriate therapy should then be selected to effectively improve the prognosis of pregnancies.
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Affiliation(s)
- Xiaoyue Wang
- Department of Hematology, No. 454 Hospital of PLA, Nanjing
| | - Yan Xu
- Department of Obstetrics and Gynecology, Huai’an Second People's Hospital, Huai’an, Jiangsu
| | - Wenxiang Luo
- Department of Obstetrics and Gynecology, No. 454 Hospital of PLA, Nanjing, People's Republic of China
| | - Hui Feng
- Department of Hematology, No. 454 Hospital of PLA, Nanjing
| | - Yizhou Luo
- Department of Hematology, No. 454 Hospital of PLA, Nanjing
| | - Yanli Wang
- Department of Hematology, No. 454 Hospital of PLA, Nanjing
| | - Hui Liao
- Department of Hematology, No. 454 Hospital of PLA, Nanjing
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12
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Zhang X, Zhao Y, Li X, Han P, Jing F, Kong Z, Zhou H, Qiu J, Li L, Peng J, Hou M. Thrombopoietin: a potential diagnostic indicator of immune thrombocytopenia in pregnancy. Oncotarget 2016; 7:7489-96. [PMID: 26840092 PMCID: PMC4884934 DOI: 10.18632/oncotarget.7106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/24/2016] [Indexed: 12/13/2022] Open
Abstract
To evaluate whether the serum thrombopoietin levels in pregnancy-associated immune thrombocytopenia (ITP) differ from those in gestational thrombocytopenia, and reveal the possibility of thrombopoietin serving as a marker for differential diagnosis. Serum thrombopoietin concentration was determined in ITP in pregnancy (n = 35), gestational thrombocytopenia (n = 31), healthy pregnancy (n = 32), age-matched nonpregnant ITP (n = 32) and nonpregnant healthy controls (n = 35) by ELISA. The serum thrombopoietin level of ITP in pregnancy (1283 ± 646 pg/mL) was significantly higher than gestational thrombocytopenia (187 ± 64 pg/mL) (P < 0.01), although the platelet counts of these two disorders may overlap. Twenty-nine of 35 patients with ITP in pregnancy had thrombopoietin values >500 pg/mL, whereas none of the gestational thrombocytopenia patients' thrombopoietin levels exceeded 500 pg/mL. In addition, ITP in pregnancy presented a markedly higher thrombopoietin level than nonpregnant ITP (88 ± 41 pg/mL) (P < 0.01), indicating that the pathogenesis of pregnant and nonpregnant ITP was different. Our findings suggest that measurement of serum thrombopoietin concentration provides valuable diagnostic information for differentiating ITP in pregnancy from gestational thrombocytopenia. Thrombopoietin represents a reliable marker for ITP in pregnancy.
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Affiliation(s)
- Xu Zhang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yajing Zhao
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaoqing Li
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Panpan Han
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Fangmiao Jing
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Zhangyuan Kong
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Hai Zhou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jihua Qiu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Lizhen Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China.,Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, Shandong, China.,Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Shandong University, Jinan, Shandong, China
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13
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Bergmann F, Rath W. The Differential Diagnosis of Thrombocytopenia in Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:795-802. [PMID: 26634939 PMCID: PMC4678382 DOI: 10.3238/arztebl.2015.0795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/16/2015] [Accepted: 07/16/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Thrombocytopenia is, after anemia, the second most common abnormality of the complete blood count in pregnancy, with a reported frequency of 6.6% to 11.2%. It has many causes. Thrombocytopenia should be diagnostically evaluated as early as possible in pregnancy, so that the obstetrical management can be accordingly planned to minimize harm to the mother and child. As the various underlying diseases share clinical features and laboratory findings, the differential diagnosis is often a difficult interdisciplinary challenge. METHODS In this article, we review pertinent literature (2000-January 2015) retrieved by a selective search in PubMed. RESULTS Gestational thrombocytopenia is the most common type, accounting for 75% of cases, followed by severe pre-eclampsia/HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) in 15-22% and autoimmune thrombocytopenia (ITP) in 1-4%. Gestational thrombocytopenia and ITP differ in the bleeding history, the severity of thrombocytopenia, the frequency of neo - natal thrombocytopenia, and the rate of normalization of the platelet count after delivery. The HELLP syndrome and rarer microangiopathic hemolytic anemias (e.g., thrombotic thrombocytopenic purpura) can be differentiated on the basis of their main clinical features, such as hypertension/proteinuria and upper abdominal pain, the severity of hemolysis and thrombocytopenia, the degree of transaminase elevation, and the rapidity of postpartum remission of the clinical and laboratory findings. A stepwise diagnostic procedure should be followed to distinguish further causes, e.g., to differentiate thrombocytopenia due to infection, autoimmune disease, or drugs from thrombocytopenia due to a rare hereditary disease. CONCLUSION The early interdisciplinary evaluation of thrombocytopenia in pregnancy is a prerequisite for the optimal care of the mother and child. The development of evidence-based recommendations for interdisciplinary management should be a goal for the near future.
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Affiliation(s)
| | - Werner Rath
- Faculty of Medicine, Gynecology and Obstetrics, University Hospital RWTH Aachen
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