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Fetal and Maternal Medicine Review Fetal and Maternal Medicine Review

Article contents

DIAGNOSIS AND MANAGEMENT OF THROMBOCYTOPENIA IN PREGNANCY

Published online by Cambridge University Press:  04 May 2011

BETHAN MYERS  and
EDWARD TRUELOVE
BETHAN MYERS
Affiliation:
Lincoln County Hospital
EDWARD TRUELOVE
Affiliation:
Department of Haematology, Nottingham University Hospitals
Corresponding
E-mail address:
bethan.myers@btinternet.com
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Extract

Platelets are an essential component of the first step in the process of haemostasis, plugging defects in the endothelium and providing a surface for secondary haemostasis to occur, via the coagulation pathway. Platelet aggregation and activation cause granule release of von Willebrand factor, ADP and serotonin, which, in turn, results in recruitment of more platelets to form the platelet plug. This serves to stop the bleeding, and also to activate the coagulation pathway on the surface of the activated platelets, leading to a firm fibrin clot.

Type
Research Article
Information
Fetal and Maternal Medicine Review , Volume 22 , Issue 2 , May 2011 , pp. 144 - 167
Copyright
Copyright © Cambridge University Press 2011

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References

1Provan, D, Stasi, R, Newland, A, Blanchette, VS, Bolton-Maggs, P et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115: 168–86.CrossRefGoogle ScholarPubMed
2Verdy, E, Bessous, V, Dreyfus, MKaplan, C, Tchernia, G, Uzan, S. Longitudinal analysis of platelet count and volume in normal pregnancy. Thromb Haemost 1997; 77: 806–807.Google ScholarPubMed
3Boehlen, F, Hohlfeld, H, Extermann, P, Perneger, T, de Moerloose, P. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 2000; 95: 29–33.Google ScholarPubMed
4Calderwood, C. Thromboembolism and thrombophilia in pregnancy. Curr Obstet Gynaecol 2006; 16: 321–26.CrossRefGoogle Scholar
5Burrows, RF, Kelton, JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J Obstet Gynecol 1990; 162: 732–34CrossRefGoogle ScholarPubMed
6McCrae, KR, Samuels, P, Schreiber, AD. Pregnancy-associated thrombocytopenia: pathogenesis and management. Blood 1992; 80: 2697–714.Google ScholarPubMed
7Win, N, Rowley, M, Pollard, CBeard, J, Hambley, H, Booker, M. Severe gestational (incidental) thrombocytopenia: to treat or not to treat. Haematology 2005; 10: 69–72.CrossRefGoogle ScholarPubMed
8Nugent, D, McMillan, R, Nichol, JL, Slichter, SJ. Pathogenesis of chronic immune thrombocytopenia: increased platelet destruction and/or decreased platelet production. Br J Haematol 2009; 146: 585–96CrossRefGoogle ScholarPubMed
9Rodeghiero, F, Stasi, R, Germsheimer, T, Michel, M, Provan, D, Arnold, DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113: 2386–393.CrossRefGoogle ScholarPubMed
10Segal, JB, Powe, NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost 2006; 4: 237–83.CrossRefGoogle ScholarPubMed
11Neylon, AJ, Saunders, PW, Howard, MR, Proctor, SJ, Taylor, PR. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 2003; 122: 966–74.CrossRefGoogle ScholarPubMed
12Gill, KK, Kelton, JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Haematol 2000; 37: 275–89.CrossRefGoogle ScholarPubMed
13Kuter, DJ. New thrombopoietic growth factors. Blood 2007; 109: 4607–16.CrossRefGoogle ScholarPubMed
14Fujimura, K, Harada, Y, Fujimoto, T, Kuramoto, A, Ikeda, Y, Akatsuka, J et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int J Haematol 2002; 75: 426–33.CrossRefGoogle ScholarPubMed
15Leibman, HA, Stasi, R. Secondary immune thrombocytopenic purpura. Curr Opin Hematol 2007; 14: 557–73.CrossRefGoogle Scholar
16British Committee for Standards in Haematology General Haematology task force. Guidelines for investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120: 574–96.CrossRefGoogle Scholar
17Webert, KE, Mittal, R, Sigouin, C, Heddle, NM, Kelton, JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102: 4306–11.CrossRefGoogle ScholarPubMed
18Letsky, EA, Greaves, M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology. Br J Haematol 1996; 95: 21–26.Google ScholarPubMed
19Lyall, H, Myers, B. Maternal autoimmune cytopenias; In: Pavord, S, Hunt, B (eds). The Obstetric Hematology Manual Cambridge University Press, 2010, Ch 4, 45–59.CrossRefGoogle Scholar
20Michel, M, Novoa, MV, Bussel, JB. Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. Br J Haematol 2003; 123: 142–46.CrossRefGoogle ScholarPubMed
21Klink, DT, van Elburg, RM, Schreurs, MW, van Well, GT. Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clin Dev Immunol 2008: 271–363.Google Scholar
22Samuels, P, Bussel, JB, Braitman, LE, Tomaski, A, Druzin, ML, Mennutti, MT et al. , Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura. N Engl J Med 1990; 323: 229–35.CrossRefGoogle ScholarPubMed
23Cines, DB, Bussel, JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005; 106: 2244–251.CrossRefGoogle Scholar
24Christiaens, GC, Niewenhuis, HK, Bussel, JB. Comparison of platelet counts in first and second newborns of mothers with immune thrombocytopenic purpura. Obstet Gynecol 1997; 90: 546–52.CrossRefGoogle ScholarPubMed
25Scioscia, AL, Grannum, PA, Copel, JA, Hobbins, JC. The use of percutaneous umbilical blood sampling in immune thrombocytopenic purpura. Am J Obstet Gynecol 1988; 159: 1066–68.CrossRefGoogle ScholarPubMed
26Douglas, MJ. The use of neuraxial anesthesia in parturients with thrombocytopenia: what is an adequate platelet count? Evidence-Based Obstetric Anesthesia. Malden, MA: Blackwell; 200: 165–177Google Scholar
27American College of Obstet Gynecol, ACOG Practice Bulletin: diagnosis and management of pre-eclampsia in pregnancy. Obstet Gynecol 2002; 99: 159–67.Google Scholar
28Mirza, FG, Cleary, KL. Pre-eclampsia and the kidney. Semin Perinatol 2009; 33: 173–78.CrossRefGoogle ScholarPubMed
29Maynard, SE, Venkatesha, S, Thadhani, R, Karumanchi, SA. Soluble Fms-like tyrosine kinase 1 and endothelial dysfunction in the pathogenesis of pre-eclampsia. Pediatr Res 2005; 57: 1R–7R.CrossRefGoogle Scholar
30Venkatesha, S, Toporsian, M, Lam, C, Hanai, J, Mammoto, T, Kim, Y et al. Soluble endoglin contributes to the pathogenesis of pre-eclampsia. Nat Med 2006; 12: 642–49.CrossRefGoogle Scholar
31Myatt, L, Webster, RP. Vascular biology of pre-eclampsia. Thromb Haemost 2009; 7: 375–84.CrossRefGoogle Scholar
32Kirkpatrick, CA. The HELLP syndrome. Acta Clin 2010; 65: 91–97.CrossRefGoogle ScholarPubMed
33Fakhouri, F, Jablonski, M, Lepercq, J, Blouin, J, Benachi, A, Hourmant, M et al. Factor H, membrane cofactor protein, and factor I mutations in patients with haemolysis, elevated liver enzymes, and low platelet syndrome. Blood 2008; 112: 4542–545.CrossRefGoogle Scholar
34Vesely, SK, George, JN, Lammle, B, Studt, J, Alberio, L, El-Harake, MA et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura- haemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood 2003; 102: 60–68.CrossRefGoogle Scholar
35Martin, J, Bailey, AP, Rehberg, JF, Owens, MT, Keiser, SD, May, WL. Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2008. Am J Obstet Gynecol 2008; 199: 98–104CrossRefGoogle Scholar
36Sadler, JE. Von Willebrand factor, ADAMTS13 and thrombotic thrombocytopenic purpura. Blood 2008; 112: 11–18.CrossRefGoogle ScholarPubMed
37Sanchez-Luceros, A, Farias, CE, Amaral, MMKempfer, AC, Votta, R, Marchese, C et al. von Willebrand factor-cleaving protease (ADAMTS13) activity in normal non-pregnant women, pregnant and post delivery women. Thromb Haemost 2004; 92: 1320–326.Google ScholarPubMed
38Kremer, Hovinga JA, Meyer, SC. Current management of thrombotic thrombocytopenic purpura. Curr Opin Hematol 2008; 15: 445–50.CrossRefGoogle Scholar
39Vesely, SK, Li, X, McMinn, JRTerrell, DR, George, JN. Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Transfusion 2004; 44: 1149–158.CrossRefGoogle ScholarPubMed
40Caprioli, J, Noris, M, Brioschi, S, Pianetti, G, Castelletti, F, Bettinaglio, P et al. Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood 2006; 108: 1267–279.CrossRefGoogle Scholar
41Fakhouri, F, Roumenina, L, Provot, F, Sallee, S, Caillard, L, Couzi, M et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 21: 859–67.CrossRefGoogle ScholarPubMed
42Mache, CJ, Cham-Roschitz, B, Fremeaux-Bacchi, V, Kirschfink, M, Zipfel, PF, Roedl, S et al. Complement inhibitor eculizumab in atypical hemolytic uremic syndrome. Clin J Am Soc Nephrol 2009; 4: 1312–316.CrossRefGoogle ScholarPubMed
43McCrae, KR, Cines, DB. Thrombotic microangiopathy in pregnancy. Semin Hematol 1997; 34: 148–58.Google Scholar
44McCrae, KR. Thrombocytopenia in pregnancy. In: Michelson, AD (ed) Platelets. New York, NY: Elsvier; 2006: 925–33.Google Scholar
45Pavord, S. Inherited disorders of primary hemostasis. In: Pavord, S, Hunt, B (eds). The Obstetric Hematology Manual Cambridge University Press, 2010, Ch 14: 176–85.CrossRefGoogle Scholar
46Harenberg, J, Jorg, I, Bayerl, C, Fiehn, C. Treatment of a woman with lupus pernio, thrombosis and cutaneous intolerance to heparin using lepirudin during pregnancy. Lupus 2005; 14: 411–12.CrossRefGoogle ScholarPubMed
47Huhle, G, Gerberth, M, Hoffman, U, Heene, Dl, Harenberg, J. management of heparin-associated thrombocytopenia in pregnancy with subcutaneous r-hirudin. Gynaecol Obstet Invest 2000; 49: 67–69.CrossRefGoogle ScholarPubMed
48Myers, B, Westby, J, Strong, J. Prophylactic use of danaparoid in high-risk pregnancy with heparin-induced thrombocytopenia positive skin reaction. Blood Coag Fibrinolysis 2003; 14: 485–87.CrossRefGoogle ScholarPubMed
49Schindlewolf, M, Mosch, G, Bauersachs, RM, Lindhoff-Last, E. Safe anticoagulation with danaparoid in pregnancy and lactation. Thromb Haemost 2004; 92: 211.Google Scholar
50Murphy, M. Fetal/neonatal alloimmune thrombocytopenia. In: Pavord, S, Hunt, B (eds) The Obstetric Hematology Manual. Cambridge University Press, 2010, Ch 5, 63–72.CrossRefGoogle Scholar

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