Thrombocytopenia, defined as a platelet count pregnancy. In cases of itp, care of the mother centers on minimizing her risk of bleeding during pregnancy and childbirth. Idiopathic thrombocytopenia purpura itp in adults fact sheets. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last.
Thrombocytopenia during pregnancy is associated with many diseases, of which idiopathic thrombocytopenic purpura is the most common in the first trimester. Postpartum thrombotic thrombocytopenic purpura ttp. Jan 03, 20 thrombocytopenia, defined as a platelet count 26 000 women suggest that its prevalence at the end of pregnancy is between 6. Medical management of itp in pregnancy ash and bcsh guidelines. Although pregnancy is associated with physiological changes in. The diagnosis and distinction between gestational thrombocytopenia and itp is. Immune thrombocytopenic purpura itp is a condition which causes the number of platelets in your blood to be reduced. In pregnancy, treatment for immune thrombocytopenic purpura itp and neonatal alloimmune thrombocytopenia nait involves two patients. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy.
What is idiopathic thrombocytopenia purpura or itp. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. Thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. Immune thrombocytopenic purpura in pregnancy request pdf. Cases thought to be due to immune thrombocytopenic purpura or. There are many potential causes of pregnancy associated thrombocytopenia. Jan 25, 2015 idiopathic autoimmune thrombocytopenic purpuraitp the most common cause of acute onset of thrombocytopenia in an otherwise well child estimated about 1 in 20,000 children a recent history of viral illness is described in 5065% of cases of childhood itp 1252015 idiopathic thrombocytopenic purpura prof. Several other researchers have reported similar results. Haematology department immune thrombocytopenic purpura. As usual, situations in real life are often more complicated than in guidelines. Itp and pregnancy blood american society of hematology. Platelets are small plateshaped bodies in the blood that combine to form a plug when a blood vessel is injured. Apr 30, 2019 immune thrombocytopenia itp is a disorder that can lead to easy or excessive bruising and bleeding. Immune idiopathic thrombocytopenic purpura adult itp is usually a chronic condition,often occurring among young women.
This disorder usually develops in the late second or third trimester and generally affects women with no prior history of. Despite its rarity compared to gestational thrombocytopenia vide infra, itp is the most common cause of isolated thrombocytopenia in the first and early second trimesters 3,6,911. The following organizations have issued guidelines for the management of immune thrombocytopenia itp during pregnancy. Infants born to pregnant women with idiopathic thrombocytopenic purpura can develop thrombocytopenia, because the antiplatelet antibody that causes the illness can cross the placenta. Maternal thrombocytopenia in pregnancy usha perepu, mbbs 1 lori rosenstein, md 1 keywords.
Several other researchers have reported similar results in previous studies, 25. Jul 01, 2000 management of idiopathic thrombocytopenic purpura in pregnancy management of idiopathic thrombocytopenic purpura in pregnancy gill, karamjit k. Aug 19, 2019 in pregnancy, treatment for immune thrombocytopenic purpura itp and neonatal alloimmune thrombocytopenia nait involves two patients. Guidelines for the investigation and management of. Idiopathic thrombocytopenic purpura, or itp, is a bleeding disorder caused by an abnormally low level of platelets in the patients blood. Pdf idiopathic thrombocytopenic purpura and anaemia in a. Presentation and outcome of idiopathic thrombocytopenic purpura. Findings of our study reveal that, pregnancy in women with idiopathic thrombocytopenic purpura can be safe. Thrombocytopenia in pregnancy hematology american society of. Formerly known as idiopathic thrombocytopenic purpura, itp can cause purple bruises, as well as tiny reddishpurple dots that look like a rash. Pregnancy in patients with idiopathic thrombocytopenic purpura.
Idiopathic thrombocytopenic purpura itp is a condition that often develops in young women, and, consequently, physicians will frequently manage pregnant patients with this disorder. Idiopathic thrombocytopenic purpura and anaemia in a pregnant mare. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura itp or chronic itp citp diagnosed before or during pregnancy. Autoimmune thrombocytopenia idiopathic or related to drugs, systemic lupus erythematosus, antiphospholipid antibodies, or hiv major causes of thrombocytopenia during pregnancy. Idiopathic thrombocytopenic purpura itp is a common hematologic disorder caused by immunemediated thrombocytopenia. Severe thrombocytopenia in the third trimester of pregnancy. A challenging situation is the association of itp with pregnancy, which further increases the risk due to the immunodeficiency of pregnancy, major dangers of bleeding, vital risks for mother and fetus, potential risks of medication, necessity of prompt intervention in the setting of specific obstetrical situations delivery, pregnancy loss.
Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Thrombotic thrombocytopenic purpura ttp is a serious condition resulting from platelet aggregation mainly at a microcirculation level. Despite its rarity compared to gestational thrombocytopenia vide infra, itp is the most common cause of isolated thrombocytopenia. In healthy people, old platelets are destroyed in the spleen by a type of white cell called a macrophage. Splenectomy for idiopathic thrombocytopenic purpura had been done at various intervals before pregnancy in 8 patients. A low platelet count is often an incidental feature, but it might. Therefore, itp is a condition generally diagnosed by exclusion of the numerous other. Management of idiopathic thrombocytopenic purpura in pregnancy.
Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. Thrombocytopenia and idiopathic thrombocytopenic purpura. Guideline for the management of thrombocytopenia in. The incidence of immune thrombocytopenic purpura in children and adults. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy idiopathic thrombocytopenic purpura itp is an autoimmune disorder characterized by persistent thrombocytopenia. Thrombocytopenia differential diagnosis falsely low platelet count in vitro platelet clumping caused by edtadependent agglutinins giant platelets common causes of thrombocytopenia pregnancy gestational thrombocytopenia, preeclampsia druginduced thrombocytopenia. Idiopathic thrombocytopenia purpura itp is an acquired disorder, resulting from an increase in the breakdown of platelets. Conclusions influenza a can induce secondary itp in pregnancy, and the standard treatment for both itp and. Thrombocytopenia occurs in 810% of all pregnancies. Inherited thrombotic thrombocytopenic purpura mimicking. Moderate to severe thrombocytopenia during pregnancy.
Racgp incidentally detected thrombocytopaenia in adults. This document is valid only on date last printed page 4 of 8 maternity guidelines thrombocytopenia in pregnancy gl927 october 2017 5. A retrospective analysis of 30 pregnancies in 26 women with idiopathic thrombocytopenic purpura. We report the case of a young pregnant woman with refractory immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenic purpura and was successfully treated with plasmapheresis. Gestational thrombocytopenia is the most common cause of thrombocytopenia in pregnancy, affecting 5% of all pregnancies and accounting for more than 75% of cases of pregnancy associated thrombocytopenia 4,6,10,25,8385. The diagnosis and distinction between gestational thrombocytopenia and itp is important and requires assessment of the timing and degree of thrombocytopenia. Immune thrombocytopenia itp occurs in one or two of every 1,000 pregnancies, and accounts for 5% of cases of pregnancy associated thrombocytopenia. Effect of pregnancy on the course of immune thrombocytopenia. Page 6 of 11 idiopathic thrombocytopenia purpura pregnancy itp in pregnancy must be differentiated from the following. Primary immune thrombocytopenic purpura autoimmune thrombocytopenic purpura it is defined as an isolated thrombocytopenia with normal bone marrow in the absence of other causes of thrombocytopenia. Pregnancy outcomes in women with idiopathic thrombocytopenic. To study the outcome of pregnancy in women with idiopathic thrombocytopenic purpura. How i treat thrombocytopenia in pregnancy american society of.
Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets. Although immune thrombocytopenic purpura in pregnancy is common, thrombotic thrombocytopenic purpura is rare and requires aggressive therapy. The incidence of bleeding episodes in antenatal period, severe thrombocytopenia and hemorrhagic complications at the time of delivery was 30, 37 and 11. Patients should seek further advice and information about idiopathic thrombocytopenia purpura itp in adults and or their individual condition from their treating haematologist or doctor. The management of idiopathic thrombocytopenic purpura itp during pregnancy can be challenging. Platelets are small blood cells needed for normal blood clotting. A retrospective analysis of 30 pregnancies in 26 women with idiopathic thrombocytopenic purpura was carried out. Studies from the group at mcmaster university over the past decade have changed the way we manage pregnancy in women with itp. Idiopathic thrombocytopenic purpura itp is a disease that commonly affects women of reproductive age and is associated with maternal and fetal. Dec 08, 2017 thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. Immune idiopathic thrombocytopenic purpura itp is an autoimmune disorder. The most common type is pregnancy associated thrombocytopenia pat, which accounts for 65% to 80% of the cases, followed by idiopathic thrombocytopenia itp and hypertensive disorder in pregnancy pih.
Itp has 2 distinct clinical syndromes, manifesting as an acute condition in children and a chronic condition in adults. The bleeding results from unusually low levels of platelets the cells that help blood clot. How i treat thrombocytopenia in pregnancy blood american. Differential diagnosis of gestational thrombocytopenia versus itp. Thrombocytopenia in pregnancy hematology american society. Immune thrombocytopenia itp diagnosis and treatment. Kelton idiopathic thrombocytopenic purpura itp is a relatively common autoimmune disorder among women of childbearing age.
Cases thought to be due to immune thrombocytopenic purpura. Dec 14, 2019 immune thrombocytopenia itp, previously known as idiopathic thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow and in the absence of other causes of thrombocytopenia. Primary immune thrombocytopenic purpura itp, also referred to as idiopathic thrombocytopenic purpura, is an organspecific autoimmune disorder in which antibodycoated or immune complexcoated platelets are destroyed prematurely by the reticuloendothelial system, resulting in peripheral blood thrombocytopenia. The impact of idiopathic thrombocytopenic purpura in. The study by webert and colleagues in this issue of blood page 4306 describes the largest cohort of pregnant. Review thrombocytopenia in preg nancy author bethan myers key content. Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal. Idiopathic thrombocytopenic purpura genetic and rare. She was diagnosed with itp and treated with intravenous immunoglobulin and oseltamivir. Management of the pregnant patient with idiopathic. Major causes of thrombocytopenia during pregnancy spurious, due to edtainduced platelet aggregation gestational thrombocytopenia preeclampsiaeclampsia, including hellp syndrome autoimmune thrombocytopenia idiopathic or related to drugs, systemic lupus erythematosus, antiphospholipid antibodies, or hiv. In some cases, the thrombocytopenia is also immunemediated.
Idiopathic thrombocytopenic purpura itp, also known as primary immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow and in the absence of other causes of thrombocytopenia. To diagnose immune thrombocytopenia, your doctor will try to exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you or your child may be taking. Idiopathic thrombocytopenia purpura is a blood disorder affecting the platelets. Idiopathic thrombocytopenic purpura itp new era for an. Platelet kinetics were studied in 18 patients with idiopathic thrombocytopenic purpura itp before splenectomy, 1 month and 8 months after. Itp has until recently been termed idiopathic thrombocytopenic purpura, but was changed to immune thrombocytopenia to reflect the fact that many patients do not experience purpura and in the majority of cases it is an immune autoimmune rather than an idiopathic. Immune thrombocytopenia itp symptoms and causes mayo clinic. Pregnancy status medications, including heparin, alcohol, quinidinequinine, and sulphonamides, which may cause thrombocytopenia. Management of idiopathic thrombocytopenic purpura in pregnancy fhamjit k gill andjohn g. Idiopathic thrombocytopenic purpura itp is a bleeding disorder characterized by too few platelets in the blood. Pdf pregnancy in chronic immune thrombocytopenic purpura. Her platelet count returned to normal by day 8, and she delivered vaginally a normal infant who had no evidence of thrombocytopenia or influenza. Pdf idiopathic thrombocytopenic purpura in pregnancy.
Thrombocytopenia affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy. Management of idiopathic thrombocytopenia during pregnancy. This is because platelets are being destroyed by the immune. The first line of treatment in itp is corticosteroid therapy 1, 57, 12, however patients on steroids have an increased risk of. It is a condition in, which there is bruising purpura because there are fewer platelets in the blood than usual thrombocytopenia and it is not known what causes it idiopathic. We observed pregnant women of 70 females with idiopathic thrombocytopenic purpura itp from january 1992 through september 2002. Immune thrombocytopenic purpura itp in pregnancy information for patients. Webmd explains the causes, symptoms, and treatment of thrombocytopenia and itp, conditions that cause you to have an abnormally low number of platelets in your blood. A practice guideline developed by explicit methods for the american society of hematology by james n. Immune thrombocytopenia itp, also called idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura is an acquired thrombocytopenia caused by autoantibodies against platelet antigens.
It is one of the more common causes of thrombocytopenia. Rare causes can be associated with severe complications for mother and baby. It is a diagnosis of exclusion,although in approximately twothirds of cases the diagnosis. Maternal and perinatal outcome in idiopathic thrombocytopenic purpura itp with pregnancy. Risk factors for neonatal thrombocytopenia in pregnancy complicated by idiopathic thrombocytopenic purpura. The impact of this disease on pregnancy has been studied by analyzing case reports, but this method can give inaccurate estimates. The magnitude of the maternalfetal risk of itp during pregnancy. Management of immune thrombocytopenic purpura in adults. A linkage of mothers and babies within a large us health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with itp or. Presentation and outcome of idiopathic thrombocytopenic purpura in a single australian centre.
Moderate to severe thrombocytopenia during pregnancy michal parnasa, eyal sheinerb, ilana shohamvardic, eliezer bursteinb, tikva yermiahud, itai levid, gershon holcbergb, ronit yerushalmid afaculty of health science, soroka university medical center, ben gurion university of the negev, beersheva, israel. Out of 26 patients with idiopathic thrombocytopenic purpura, 16 were already diagnosed while the other 10 were diagnosed during pregnancy. Itp has two distinct clinical syndromes, manifesting as an acute condition in children and a chronic condition in adults. The diagnosis and distinction between gestational thrombocytopenia and itp is important and.
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