Glanzmann's thrombasthenia during pregnancy complicated by large subchorionic hematoma managed with antifibrinolytics, human leukocyte antigen-matched platelet transfusion, and primary cesarean delivery: a case report

Winget, V.; Schoenhage, Monique Brown; Orth, Teresa

doi:10.1016/j.xagr.2021.100031

Cited by 1 publication

(2 citation statements)

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“…24,25 Rare reports have described obstetric bleeding including vaginal bleeding from a placenta previa managed with unmatched platelets 26 and a subchorionic hematoma managed supportively. 27 Furthermore, more than 70% of pregnant GT patients had detectable levels of anti-platelet antibodies, particularly anti-GPIIb/ IIIa, 17,25 which have the potential to make patients refractory to platelet transfusions and can lead to NAIT and fetal demise. 15 Given these risks, pre-pregnancy counseling plays an important role in evaluating outcomes in patients with GT.…”

Section: Discussionmentioning

confidence: 99%

“…Pregnant GT patients are reported to experience high rates of antepartum bleeding which have largely been non‐obstetric in nature (e.g., epistaxis, gingival bleeding) and managed supportively 24,25 . Rare reports have described obstetric bleeding including vaginal bleeding from a placenta previa managed with unmatched platelets 26 and a subchorionic hematoma managed supportively 27 . Furthermore, more than 70% of pregnant GT patients had detectable levels of anti‐platelet antibodies, particularly anti‐GPIIb/IIIa, 17,25 which have the potential to make patients refractory to platelet transfusions and can lead to NAIT and fetal demise 15 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multidisciplinary management of a pregnancy complicated by Glanzmann thrombasthenia: A case report

Hernandez,

Buckley,

Mills

et al. 2023

Transfusion

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BackgroundGlanzmann thrombasthenia (GT) is a rare, autosomal recessive disorder of platelet glycoprotein IIb‐IIIa receptors. Pregnant patients with GT are at increased risk of maternal and fetal bleeding. There is a paucity of literature on the peripartum management of patients.Case DescriptionWe present the antepartum through the postpartum course of a patient with GT who was managed by a multidisciplinary approach that included communication across maternal‐fetal medicine, hematology, transfusion medicine, and anesthesiology services. In addition to routine prepartum obstetric imaging and hematologic laboratory studies, we proactively monitored the patient for anti‐platelet antibodies every 4–6 weeks to gauge the risk for neonatal alloimmune thrombocytopenia. Furthermore, we prioritized uterotonics, tranexamic acid, and transfusion of HLA‐matched platelets to manage bleeding for mother and fetus intrapartum through the postpartum periods.ConclusionTo date, there are limited guidelines for managing bleeding or preventing alloimmunization during pregnancy in patients with GT. Here, we present a complex case with aggressive management of bleeding prophylactically for the mother while serially monitoring both mother and fetus for peripartum bleeding risks and events. Moreover, future studies warrant continued evaluation of these approaches to mitigate increased bleeding risks in subsequent pregnancies.

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