Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

Valat, A. S.; Caulier, Mathieu; Devos, Patrick; Rugeri, Lucia; Wibaut, B.; Vaast, P.; Puech, F; Bauters, F; Jude, Brigitte

doi:10.1046/j.1365-2141.1998.01006.x

Cited by 88 publications

(91 citation statements)

References 24 publications

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“…Gernsheimer et al [21], recommend the use of corticosteroids or IVIG if platelet count falls below 20--30 × 10 9 /L. Some studies consider the following as important predictors of an increased risk of neonatal thrombocytopenia: maternal history of splenectomy, maternal platelet count of < 50 × 10 9 /L at some point during the pregnancy, and a previous pregnancy complicated with neonatal thrombocytopenia [23][24][25][26]. Noris et al [27], performed a multicenter, retrospective study evaluating 339 pregnancies in 181 women.…”

Section: Discussionmentioning

confidence: 99%

Fetal-maternal complications and their association with gestational thrombocytopenia

Elveđi-Gašparović

Beljan²,

Gverić-Ahmetašević³

et al. 2016

Ginekol Pol

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Objectives: Thrombocytopenia is defined as a platelet count of < 150 × 10 9 /L. It is a common hematologic abnormality during pregnancy. Evaluation and treatment of gestational thrombocytopenia can be both, expensive and invasive, and may result in an adverse outcome. The aim of our study was to investigate the incidence of perinatal complications in pregnancies complicated with gestational thrombocytopenia and to determine if the severity of maternal gestational thrombocytopenia implicates unfavorable perinatal outcome. Material and methods:Over a period of three years, we identified 50 patients with gestational thrombocytopenia: 38 with platelet count between 50-100 × 10 9 /L -classified as moderate thrombocytopenia, and 12 with platelet count of < 50 × 10 9 /L -classified as severe thrombocytopenia. Fifty women with normal platelet count constituted the control group. Maternal complications and neonatal outcomes were compared. Results:Neonatal thrombocytopenia occurred more often in pregnancies complicated with gestational thrombocytopenia (p = 0.041). Thrombocytopenia in previous pregnancy seems to be an important predicting factor for disease severity in the current pregnancy (p = 0.01). Conclusions:Gestational thrombocytopenia, even if severe, is not associated with adverse maternal or neonatal outcome. Moderate neonatal thrombocytopenia is more common in pregnancies complicated with severe gestational thrombocytopenia. The incidence of severe gestational thrombocytopenia is higher in patients with thrombocytopenia in previous pregnancy.

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Section: Discussionmentioning

confidence: 99%

Fetal-maternal complications and their association with gestational thrombocytopenia

Elveđi-Gašparović

Beljan²,

Gverić-Ahmetašević³

et al. 2016

Ginekol Pol

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“…Recently, Roberts et al mentioned in their review of neonatal thrombocytopenia that the severity of maternal thrombocytopenia during pregnancy or the occurrence of severe thrombocytopenia in a previous neonate are the most useful parameters for predicting the occurrence of NITP [30]. Some literature also supported the hypothesis of the correlation between the severity of maternal thrombocytopenia and the occurrence of NITP [20,31,32]. This agenda remains debatable in the future.…”

Section: Prediction Of Nitpmentioning

confidence: 99%

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

et al. 2011

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Of infants born to women with idiopathic thrombocytopenic purpura (ITP), about 10-15% have transient neonatal immune thrombocytopenic purpura (NITP). Of concern is the lack of a reliable predictor for NITP. We conducted a retrospective study of all pregnancies with ITP at Osaka University Hospital over the past 16 years analyzing a total of 127 pregnancies in 88 women with ITP to assess the predictive value of various clinical factors regarding neonatal platelet count in the current pregnancy. We also reviewed the literature concerning ITP in pregnancy and NITP prediction. Neonatal platelet counts were less than 100 3 10 9 /L in 20 of 130 neonates (15.4%), less than 50 3 10 9 /L in 11 neonates (8.5%), and less than 20 3 10 9 /L in three neonates (2.3%). There was a strong correlation between the first and second sibling regarding the occurrence and the severity of NITP with Spearman correlation coefficient of 0.55 (P 5 0.001) at birth and 0.63 (P < 0.0001) at nadir after birth. A maternal platelet count less than 100 3 10 9 /L at delivery showed a statistical trend for an association with the occurrence of NITP (P 5 0.043). Moreover, maternal ITP refractory to splenectomy correlated with a higher risk for fetal or neonatal ICH according to the review of the literature. In conclusion, pregnant women who have had a previous offspring with NITP or who have ITP refractory to splenectomy may be at particular risk of delivering an offspring with significant NITP. Management decisions, including mode of delivery, may be altered by the degree of risk for potentially severe NITP. Am. J. Hematol. 87:15-21, 2012. V

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“…46,47 However, women in remission after splenectomy may relapse during pregnancy, and the fetus/neonate may develop thrombocytopenia, even if the splenectomized mother remains in remission. 48 …”

Section: Prosmentioning

confidence: 99%

How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment

Ghanima

Godeau

Cines

et al. 2012

Blood

210

157

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The paradigm for managing primary immune thrombocytopenia (ITP) in adults has changed with the advent of rituximab and thrombopoietin receptor agonists (TPO-RAs) as options for second-line therapy. Splenectomy continues to provide the highest cure rate (60%-70% at 5؉ years). Nonetheless, splenectomy is invasive, irreversible, associated with postoperative complications, and its outcome is currently unpredictable, leading some physicians and patients toward postponement and use of alternative approaches. An important predicament is the lack of studies comparing secondline options to splenectomy and to each other. Furthermore, some adults will improve spontaneously within 1-2 years. Rituximab has been given to more than 1 million patients worldwide, is generally well tolerated, and its short-term toxicity is acceptable. In adults with ITP, 40% of patients are complete responders at one year and 20% remain responders at 3-5 years. Newer approaches to using rituximab are under study. TPO-RAs induce platelet counts > 50 000/L in 60%-90% of adults with ITP, are well-tolerated, and show relatively little short-term toxicity. The fraction of TPO-RA-treated patients who will be treatment-free after 12-24 months of therapy is unknown but likely to be low. As each approach has advantages and disadvantages, treatment needs to be individualized, and patient participation in decision-making is paramount. (Blood. 2012;120(5):960-969)

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Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia

Cited by 88 publications

References 24 publications

Fetal-maternal complications and their association with gestational thrombocytopenia

Fetal-maternal complications and their association with gestational thrombocytopenia

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment

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