Thrombocytopenia in pregnant women
, 1, 1, 2, 3, 1, 1, 1, 4
Abstract
Thrombocytopenia is one of the two most common hematological problems in pregnant women. It is defined as the platelet (PLT) count below 150 × 103/μL. Gestational incidental thrombocytopenia (GIT) represents about 75% of thrombocytopenia cases in pregnancy and it is believed that GIT is secondary to accelerated platelet destruction and increased plasma volume associated with pregnancy. The pregnancy complications such as preeclampsia and its most severe form — HELLP syndrome account for 20% cases of thrombocytopenia in pregnancy and primary immune thrombocytopenic purpura (ITP) — for 3–4 percent. During ITP, maternal antiplatelet antibodies can pass through the placenta and bind to fetal thrombocytes leading to the development of fetal thrombocytopenia which occurs in about 50% cases. Even if the maternal platelet count stabilizes, the estimated fetal and neonatal risk of thrombocytopenia in ITP is approximately 30%. Other types of thrombocytopenia in pregnant women constitute 1–2% of cases (disseminated intravascular coagulation, autoimmunological diseases, congenital, infection and drug-related, concomitant with blood neoplastic diseases). Although thrombocytopenia in pregnant women usually has a mild course, in case of a significant decrease in PLT count may lead to dangerous bleeding, especially when the platelet count falls below 20 × 103/μL. Since it is important to identify the cause of thrombocytopenia and to determine the risk for both the mother and the child, this paper presents the influence of maternal thrombocytopenia on the pregnancy course as well as its etiology and diagnostics. The treatment principles are discussed.
Keywords: pregnancythrombocytopeniadiagnostic procedurestreatment
References
- Chojnowski K. Postępowanie z małopłytkowością u kobiet w ciąży. Hematologia. 2013; 4(1): 15–23.
- Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993; 329(20): 1463–1466.
- Grzyb A, Rytlewski K, Domańska A, et al. Ciąża powikłana małopłytkowością. Gin Pol. 2006; 77(9): 712–718.
- Hwa HL, Chen RJ, Chen YC, et al. Maternal and fetal outcome of pregnant women with idiopathic thrombocytopenic purpura: retrospective analysis of 25 pregnancies. J Formos Med Assoc. 1993; 92(11): 957–961.
- Schwartz KA. Gestational thrombocytopenia and immune thrombocytopenias in pregnancy. Hematol Oncol Clin North Am. 2000; 14(5): 1101–1116.
- McCrae K, Bussel J, Mannucci P, et al. Platelets: An Update on Diagnosis and Management of Thrombocytopenic Disorders. Hematology. 2001; 2001(1): 282–305.
- Shehata N, Burrows R, Kelton JG. Gestational thrombocytopenia. Clin Obstet Gynecol. 1999; 42(2): 327–334.
- McCrae K. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Reviews. 2003; 17(1): 7–14.
- Burrows R, Kelton J. Thrombocytopenia at delivery: A prospective survey of 6715 deliveries. Am J Obstet Gynecol. 1990; 162(3): 731–734.
- MAGANN E, MARTIN J. Twelve Steps to Optimal Management of HELLP Syndrome. Clin Obstet Gynecol. 1999; 42(3): 532.
- Moise K, Patton D, Cano L. Misdiagnosis of a Normal Fetal Platelet Count After Coagulation of Intrapartum Scalp Samples in Autoimmune Thrombocytopenic Purpura. Am J Perinatol. 2008; 8(05): 295–296.
- Sainio S, Kekomäki R, Riikonen S, et al. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand. 2000; 79(9): 744–749.
- McCrae KR, Samuels P, Schreiber AD. Pregnancy-associated thrombocytopenia: pathogenesis and management. Blood. 1992; 80(11): 2697–2714.
- Silver R, Berkowitz R, Bussel J. Thrombocytopenia in pregnancy. Practice bulletin, No 6. American College of Obstetricians and Gynecologists, Chicago 1999.
- Cook RL, Miller RC, Katz VL, et al. Immune thrombocytopenic purpura in pregnancy: a reappraisal of management. Obstet Gynecol. 1991; 78(4): 578–583.
- Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Hematol. 2000; 37(3): 275–289.
- Burrows RF, Kelton JG. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery. Obstet Gynecol Surv. 1993; 48(12): 781–788.
- Uhrynowska M. Małopłytkowość u kobiet ciężarnych i ich dzieci-spojrzenie immunohematologa. Postępy Nauk Medycznych. 2008; 21(12): 823–827.
- McCare KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Reviews. 2003; 17(4): 265.
- Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115(2): 168–186.
- Gisbert JP. Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis. 2010; 16(5): 881–895.
- http://medicines.org.uk/emc/medicine.
- Subbaiah M, Kumar S, Roy KK, et al. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura. Arch Gynecol Obstet. 2014; 289(2): 269–273.
- Rumi E, Bertozzi I, Casetti IC, et al. Associazione Italiana per la Ricerca sul Cancro Gruppo Italiano Malattie Mieloproliferative Investigators. Impact of mutational status on pregnancy outcome in patients with essential thrombocytemia. Haematologica. 2015; 100(11): e443–e445.
- Xu X, Liang MY, Wang JL, et al. Clinical features and outcome of pregnancy with SLE-associated thrombocytopenia. J Matern Fetal Neonatal Med. 2016; 29(5): 789–794.
