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Russell MD, Dey M, Flint J, Davie P, Allen A, Crossley A, Frishman M, Gayed M, Hodson K, Khamashta M, Moore L, Panchal S, Piper M, Reid C, Saxby K, Schreiber K, Senvar N, Tosounidou S, van de Venne M, Warburton L, Williams D, Yee CS, Gordon C, Giles I, Roddy E, Armon K, Astell L, Cotton C, Davidson A, Fordham S, Jones C, Joyce C, Kuttikat A, McLaren Z, Merrison K, Mewar D, Mootoo A, Williams E. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 2022; 62:e48-e88. [PMID: 36318966 PMCID: PMC10070073 DOI: 10.1093/rheumatology/keac551] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shropshire, UK
| | - Philippa Davie
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Alexander Allen
- Clinical Affairs, British Society for Rheumatology, London, UK
| | | | - Margreta Frishman
- Rheumatology, North Middlesex University Hospital NHS Trust, London, UK
| | - Mary Gayed
- Rheumatology, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Munther Khamashta
- Lupus Research Unit, Division of Women's Health, King's College London, London, UK
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Service, Dublin, Ireland
| | - Sonia Panchal
- Department of Rheumatology, South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Madeleine Piper
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UK
| | | | - Katherine Saxby
- Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karen Schreiber
- Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark.,Department of Regional Health Research (IRS), University of Southern Denmark, Odense, Denmark
| | - Naz Senvar
- Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sofia Tosounidou
- Lupus UK Centre of Excellence, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | - David Williams
- Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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Rizzo C, Rizzo S, Scirè E, Di Bona D, Ingrassia C, Franco G, Bono R, Quintini G, Caruso C. Thrombotic thrombocytopenic purpura: a review of the literature in the light of our experience with plasma exchange. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:521-32. [PMID: 22790258 PMCID: PMC3496241 DOI: 10.2450/2012.0122-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/05/2011] [Indexed: 12/18/2022]
Affiliation(s)
- Claudia Rizzo
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Department of Biopathology and Medical and Forensic Biotechnologies (DIBIMEF), University of Palermo, Palermo
| | - Sergio Rizzo
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Palermo
| | - Elisabetta Scirè
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Palermo
| | - Danilo Di Bona
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Palermo
| | - Carlo Ingrassia
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Palermo
| | - Giovanni Franco
- Haematology and BMT Unit, “Paolo Giaccone” University Hospital, Department of Internal and Specialist Medicine (DIMIS), University of Palermo, Palermo, Italy
| | - Roberto Bono
- Haematology and BMT Unit, “Paolo Giaccone” University Hospital, Department of Internal and Specialist Medicine (DIMIS), University of Palermo, Palermo, Italy
| | - Gerlando Quintini
- Haematology and BMT Unit, “Paolo Giaccone” University Hospital, Palermo
| | - Calogero Caruso
- Unit of Immunohaematology and Transfusion Medicine, “Paolo Giaccone” University Hospital, Department of Biopathology and Medical and Forensic Biotechnologies (DIBIMEF), University of Palermo, Palermo
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Unexpected frequency of Upshaw-Schulman syndrome in pregnancy-onset thrombotic thrombocytopenic purpura. Blood 2012; 119:5888-97. [DOI: 10.1182/blood-2012-02-408914] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Pregnancy may be complicated by a rare but life-threatening disease called thrombotic thrombocytopenic purpura (TTP). Most cases of TTP are due to an acquired autoimmune or hereditary (Upshaw-Schulman syndrome [USS]) severe deficiency of a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS13). In the present study, we performed a cross-sectional analysis of the national registry of the French Reference Center for Thrombotic Microangiopathies from 2000-2010 to identify all women who were pregnant at their initial TTP presentation. Among 592 adulthood-onset TTP patients with a severe ADAMTS13 deficiency, 42 patients with a pregnancy-onset TTP were included. Surprisingly, the proportion of USS patients (n = 10 of 42 patients [24%]; confidence interval, 13%-39%) with pregnancy-onset TTP was much higher than that in adulthood-onset TTP in general (less than 5%) and was mostly related to a cluster of ADAMTS13 variants. In the present study, subsequent pregnancies in USS patients not given prophylaxis were associated with very high TTP relapse and abortion rates, whereas prophylactic plasmatherapy was beneficial for both the mother and the baby. Pregnancy-onset TTP defines a specific subgroup of patients with a strong genetic background. This study was registered at www.clinicaltrials.gov as number NCT00426686 and at the Health Authority, French Ministry of Health, as number P051064.
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Kaiser C, Gembruch U, Janzen V, Gast AS. Thrombotic thrombocytopenic purpura. J Matern Fetal Neonatal Med 2012; 25:2138-40. [PMID: 22372758 DOI: 10.3109/14767058.2012.666586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 34-year old primipara was admitted to hospital with dichorionic-diamniotic twins in 26+3 weeks of gestation. In suspicion of HELLP-syndrome, caesarean section was performed at 27+4 weeks of gestation, because of platelet count was reduced to 44000/µl. A re-laparotomy had to be performed because of intra-abdominal bleedings. The patient was given seven packed thrombocytes and five packed erythrocytes. The patient complained about blurred vision. The right corner of the mouth was slightly depressed in terms of a facial nerve paresis. Further platelet counts were about 50000/µl. Haemoglobin: 7.8 mg/l. D-Dimer: 1066 mg/l. LDH was elevated to 1610 U/l, reticulocytes were elevated to 13.19% and haptoglobin was reduced to <0.08 g/l. The Coombs' test was negative. The ADAMTS-13 test showed a reduced activity. Hereby, the diagnoses of thrombotic thrombocytopenic purpura was confirmed. Plasma exchange is the most effective option; application of platelet concentrate should be avoided, because of worsening microangiopathy and subsequent neurological situation. After the patient has received plasma exchange, platelet count normalized. An ophthalmic examination showed a dysfunction in choroid perfusion as a cause for the blurred vision. After discharge regular lab tests were planned, but no further treatment was necessary at that point of time. The premature twins survived after ventricular haemorrhage, severe sepsis, bronchopulmonary dysplasia and other complications of neonates.
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Affiliation(s)
- Charlotte Kaiser
- Department of Obstetrics and Prenatal Medicine, University Clinics, Bonn, Germany
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Yamashita E, Okada H, Yorioka H, Fujita S, Nishi K, Komiyama Y, Kanzaki H. Successful management of pregnancy-associated thrombotic thrombocytopenic purpura by monitoring ADAMTS13 activity. J Obstet Gynaecol Res 2012; 38:567-9. [DOI: 10.1111/j.1447-0756.2011.01742.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Norheim KB, Leh S, Gøransson L. Crescentic glomerulonephritis and microangiopathic haemolytic anaemia in a patient with established systemic sclerosis. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2011; 45:470-2. [PMID: 21991985 DOI: 10.3109/00365599.2011.568955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article reports a case of Goodpasture's syndrome and microangiopathic haemolytic anaemia developing in a patient with a 2-year history of systemic sclerosis. Goodpasture's syndrome usually presents with lung haemorrhage and acute renal failure, and kidney biopsy typically shows crescentic glomerulonephritis with linear immunoglobulin staining on the glomerular basement membrane. Treatment of choice for Goodpasture's syndrome is immunosuppressive therapy and plasma exchange, which has greatly improved morbidity and mortality. This unusual case highlights that seemingly unrelated autoimmune diseases may coexist in one patient, and thorough clinical examination combined with serology and histology may be necessary for correct diagnosis.
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Affiliation(s)
- Katrine Brakke Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital Stavanger, Norway.
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