Bleeding complications associated with pregnancy with primary immune thrombocytopenia: a meta-analysis

Introduction  Immune thrombocytopenia (ITP) during pregnancy has received little attention from researchers. Reliable information about the outcome of mothers and newborns is required to properly counsel women who are pregnant or planning to become pregnant. Our primary outcomes were the frequency and severity of maternal and neonatal bleeding events in the setting of ITP in pregnancy. Mode of delivery, neonatal thrombocytopenia, and maternal/infant mortality were secondary outcomes.

Material and Methods  We comprehensively reviewed the prospective studies that enrolled ≥20 pregnant women with primary ITP. Two reviewers, blinded to each other, searched Medline and Embase up to February 2021. Meta-analyses of the maternal and newborn outcomes were performed. Weighted proportions were estimated by a random-effects model.

Results  From an initial screening of 163 articles, 15 were included, encompassing 1,043 pregnancies. The weighted event rate for bleeding during pregnancy was 0.181 (95% confidence interval [CI], 0.048–0.494). Most of these were nonsevere cases. The weighted event rates were 0.053 (95% CI, 0.020–0.134) for severe postpartum hemorrhage, 0.014 (95% CI, 0.008–0.025) for intracerebral hemorrhage, and 0.122 (0.095–0.157) for severe thrombocytopenia events in neonates (platelet count <50,000/μL). There were no reliable predictors of severe neonatal thrombocytopenia. The incidence of neonatal mortality was 1.06%. There were no maternal deaths.

Conclusion  Primary ITP in pregnant women is rarely associated with poor outcomes.

Measures to Maintain a SARS-CoV-2 Negative Inpatient Hematological Unit in the Midst of the COVID-19 Pandemic

The University Hospital of Salamanca, in Spain, had its first COVID-19 case on March 1st and as of May 11th, we had 1,100 positive cases. Based on the vulnerability of patients with blood cancers, on March 9th, the Hematology Department developed a protocol, amended as the new information was available, to maintain the Hematology Unit as a “free COVID-19 island.” The protocol included symptom-based surveys and screening tests to patients, caregivers, and healthcare personnel to identify early potential positive cases and prevent its spread. Between March 9 and April 28, 32 asymptomatic patients and caregivers were tested and 68 rT-PCR diagnostic assays have been performed with two positive results. A 106 healthcare workers have been tested (208 rT-PCR) and seven of them were positive. In summary, the implementation of preemptive measures after the first case appeared allowed us to be able to provide treatment to our patients.

Preferencias de hábitat, densidad y diversidad de las comunidades de aves en Tenerife (Islas Canarias)

Species–specific habitat preferences, density and species richness of bird communities in Teneriffe (Canary Islands) Bird distribution and abundance are described and analyzed in Teneriffe (Canary Islands). Inter–habitat differences in density, diversity and species richness are shown in table 1. Figure 2 shows the main determinants of bird species richness in Teneriffe, and tables 2 and 3 and figure 3 show the species–specific patterns of spatial variation abundance (more detailed for Anthus berthelotii, Fringilla coelebs canariensis, Fringilla teydea, Parus caeruleus teneriffae, Phylloscopus canariensis, Regulus teneriffae, Serinus canarius and Turdus merula cabrerae). Deeply transformed environments due to human impact (urban habitats, agricultural mosaics, banana plantations) have high bird densities and species richness, even higher than those measured in native, unmodified habitats such as laurel forests or mature pinewoods. Urban environments in Teneriffe are very permeable to native bird fauna, as they have been occupied by many widespread endemic species/subspecies. Many of the endemic, well defined species or subspecies of island birds have high population densities within native, untransformed habitats. Density compensation and niche expansion is not a common phenomenon in the avifauna of Teneriffe. Nevertheless, all species/subspecies broadening the inter–habitat or altitudinal distribution are endemic of the Canary Islands.