Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy

Abstract

Key Points• Maternal platelet count response was not different for IVIg and corticosteroids in this retrospective study of pregnant women with ITP.• Neonatal outcomes were overall favorable and similar after treatment of maternal ITP with IVIg or corticosteroids.Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 3 10 9 /L vs corticosteroids 77 3 10 9 /L; P 5 .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P 5 .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 3 10 9 /L and 18 (9%) had platelet counts <50 3 10 9 /L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 3 10 9 /L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP. (Blood. 2016;128(10):1329-1335

A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

“…12,26,44 Pregnancy-associated autoimmune neonatal thrombocytopenia is a self-limited disease with a platelet nadir at postnatal days 4 and 5, after which most counts will rise to normal levels within 1 month. 25 In our study, neonatal thrombocytopenia was noted in 9 neonates.…”

“…12 The management of pregnant patients with ITP remains a big challenge. Previous reports on secondary treatments are limited by either the retrospective nature or a small sample size.…”

“…In a recent retrospective study, Sun et al reported that the response rates of pregnant patients with ITP to either IVIG or corticosteroids were less than 40% and might be lower than that of the nonpregnant patients. 12 The secondary options are limited if the patients fail to respond to the primary treatments.…”

Problemy hematologiczne w okresie ciąży

“…W przypadku konieczności wykonania splenektomii optymalnym okresem jest II trymestr ciąży -około 20 t.c. Inne leki, takie jak azatiopryna, rytuksymab czy winkrystyna, są rzadko stosowane w terapii małopłytkowości u kobiet w ciąży i nie powinny być stosowane w I trymestrze [18][19][20][21]. Sposób zakończenia ciąży zależy od wskazań położniczych.…”

“…Sposób zakończenia ciąży zależy od wskazań położniczych. Cięcie cesarskie należy rozważyć w przypadkach wysokiego ryzyka urodzenia dziecka z ciężką małopłytkowością, na przykład współistnienia alloimmunologicznej małopłytko-wości płodowo-noworodkowej i w przypadkach, gdy kobieta wcześniej urodziła dziecko z głęboką małopłytkowością [15,[18][19][20][21].…”