Marked Rebound of Platelet Count in the Early Postpartum Period in a Patient with Essential Thrombocythemia

Abstract

Essential thrombocythemia (ET) occurs predominantly in the elderly, but approximately 20% of patients are <40 years old. Unlike other myeloproliferative neoplasms, ET occurs more commonly in women. We encountered a 38-year-old women diagnosed with ET who exhibited elevated platelet count in early pregnancy. Her platelet count exceeded 1500 × 109/L by late pregnancy; interferon α was administered but failed to induce an adequate response. She underwent emergency cesarean delivery at 37 weeks of gestation. Although her platelet count was 1000 × 109/L immediately after delivery, it markedly increased to 3271 × 109/L approximately 2 weeks later. Cytoreductive therapy was resumed; the subsequent course was free from complications. Several review articles have indicated that because platelet counts of patients may again increase to the pregnancy level or rebound after delivery, cytoreductive therapy should be administered if necessary. However, there is insufficient information on when therapeutic interventions are necessary and how they should be performed. It remains unknown whether the platelet count will decrease after some time without treatment if it rebounds. We hope management guidelines will be established by collecting detailed data on the postpartum course as well as during pregnancy.

Rebound of platelet count in a patient with type 2 calreticulin-mutant essential thrombocythemia in the postpartum period

“…Most experts agree that the management of ET during the postpartum period should be individualized according to the disease-related factors and patient risk of thrombosis. [19] We managed our patient by resuming her usual dose of Peginterferon Alfa-2a, resulting in a dramatic response with more than 50% reduction in her platelet count within a short period.…”

“…The cytoreductive medication was initiated in some cases during the postpartum period, whereas in other cases, conservative management was sufficient with a spontaneous decline of platelet count. Most experts agree that the management of ET during the postpartum period should be individualized according to the disease-related factors and patient risk of thrombosis [19] . We managed our patient by resuming her usual dose of Peginterferon Alfa-2a, resulting in a dramatic response with more than 50% reduction in her platelet count within a short period.…”

Philadelphia chromosome-negative myeloproliferative neoplasms in younger adults: A critical discussion of unmet medical needs, with a focus on pregnancy

“…While platelets count gradually decreases during pregnancy, clinicians dealing with pregnant women with MPN need to be aware that platelet count may rapidly rise after delivery, with eventual severe thrombocytosis. 151 This rebound may increase the risk of vascular complications during puerperium, which is per se a period of significant thrombotic risk, both in clinical conditions associated with enhanced vascular risk, as inherited or acquired thrombophilia, and in healthy women. Indeed, risk of a venous thromboembolic event is nearly two-fold higher in the first and second trimester, nine-fold higher in the third trimester, and eighty-fold higher in the first 2 to 6 postpartum weeks, as compared to nonpregnant women.…”