Severe thrombocytopenia in pregnancy: a retrospective study

Halici-Ozturk, Filiz; Öztürk, Merve; Yakıştıran, Betül; Çağlar, Ali Turhan; Engin-Üstün, Yaprak; Özgü-Erdinç, A. Seval

doi:10.1097/mbc.0000000000000955

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…13 Because no definite evidence supports that high doses of corticosteroids are more efficacious in pregnancy, 48 some experts recommended a lower dose of 0.25-0.5 mg/kg daily to minimize steroid-related adverse effects. 5,49,50 In our study, the median prednisone dose in monotherapy was 25 mg/d (range, 5-60 mg/d). The median dose of prednisone in the combined group was 25 mg/d (range, 5-40 mg/d).…”

Section: Discussionmentioning

confidence: 74%

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

Zhu

Feng

Huang

et al. 2022

Therapeutic Advances in Hematology

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Background: The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP). Methods: Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone. Results: Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group ( p < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8–195 days), whereas that in the combination group was 14 days (range, 6–85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone. Conclusion: These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.

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Section: Discussionmentioning

confidence: 74%

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

Zhu

Feng

Huang

et al. 2022

Therapeutic Advances in Hematology

View full text Add to dashboard Cite

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“…Some of these diseases can have a major impact on pregnancy and pose a major risk to both the mother and the child. [1][2][3] Most thrombocytopenic pregnant women are healthy and were discovered by chance through blood examination. 4 Increased risk of bleeding for vaginal delivery and for caesarean sections may also require platelet transfusions with IVIG in emergency cases.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of thrombocytopenia during the third trimester of pregnancy

Musaab,

Azamat

2024

Zanco J Med Sci

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Background and objective: Thrombocytopenia, described as a platelet count of less than 150,000 mm3, is a common diagnosis during the period of pregnancy, existing in 7–12% of pregnancies. Mild thrombocytopenia occurs if platelet counts are less than 100,000 mm3, while moderate thrombocytopenia is between 50,000 and 100,000 mm3, and severe thrombocytopenia occurs if platelet counts are less than 50,000 mm3. It could be connected to physiologic changes or pathological diseases; some of them have an impact on pregnancy and may offer a serious risk to both the mother and the unborn child. This study sought to estimate the proportions of the underlying causes as well as the prevalence of thrombocytopenia among pregnant women visiting the antenatal care center in Erbil. Methods: A cross-sectional study was performed in a maternity teaching hospital in Erbil city, Kurdistan region, Iraq. A convenience sample of 600 pregnant women was used from 28 weeks to 40 weeks of gestation. Over a period of 1 year, starting in January 2021 and ending in December 2021. Results: The prevalence of thrombocytopenia among the 600 cases was 24.8%, but the majority (75.2%) had a normal platelet count; the degrees of thrombocytopenia were severe in 1.8% of the cases, mild in 8.3%, and moderate in 14.7% of the cases. Conclusion: A statistically significant association between preeclampsia and HELLP syndrome has been reported as a serious condition that leads to thrombocytopenia. High serum albumin levels in pregnant women related to hypertension had a major impact on the number of platelet counts and should be considered a severe disease.

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A Predictive Model for Treatment Effectiveness in Severe Primary Immune Thrombocytopenia during Pregnancy: A Retrospective Study in a Tertiary Critical Maternity Referral Center

Wang,

He,

Lio

et al. 2024

Gynecol Obstet Invest

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Objectives The study aimed to identify factors influencing the severity of primary immune thrombocytopenia (ITP) during pregnancy, develop a predictive model for treatment response, and report maternal and neonatal outcomes associated with severe ITP. Design A retrospective analysis was conducted on 155 pregnancies with severe ITP between January 2018 and April 2023 at a tertiary critical maternity referral center in Shanghai, China. Participants/Materials The study included 155 pregnancies diagnosed with severe ITP, divided into groups based on the lowest platelet count (<30×109/L vs. 30-50×109/L) and first-line treatment response (Non-response vs. Response). Setting The study was conducted at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, a tertiary critical maternity rescue referral center. Methods Clinical characteristics and outcomes were compared between groups. A multivariable logistic regression model was used to identify factors associated with the severity of ITP. A prediction model for treatment response was established using LASSO-logistic regression and internally validated. Results ITP severity was found to be correlated with low maximum amplitude (MA) of thrombelastography (TEG) (OR 5.43, 95% CI 1.48 to 16.00, p=0.002), bleeding events (OR 4.91, 95% CI 1.62 to 14.86, p=0.005), and low reticulocytes (OR 2.40×10-7, 95% CI 1.06×10-13 to 0.55, p=0.04). Of the 118 patients who received first-line therapy, 52 (44%) responded. The dataset was randomly split into a training (N=99) and test (N=23) set with a ratio of 8:2. A predictive nomogram was created and internally validated showing good discrimination. The model yielded an area under receiver operating characteristic curve (ROC) of 0.78 (0.69 to 0.87) and 0.85 (0.67 to 1.00) in the training and validation cohort, respectively. Earlier delivery and high rate of NICU admission occurred with severe ITP and treatment failure. Limitations The study was limited by a relatively small sample size and the retrospective observational design, which imposed limitations on the assessment of treatment efficacy. Conclusions We identified clinical predictors of ITP severity and treatment resistance during pregnancy. A nomogram predicting first-line response was validated. These findings can facilitate clinical decision-making and counseling regarding this challenging pregnancy complication.

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Severe thrombocytopenia in pregnancy: a retrospective study

Cited by 4 publications

References 27 publications

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

Prevalence and risk factors of thrombocytopenia during the third trimester of pregnancy

A Predictive Model for Treatment Effectiveness in Severe Primary Immune Thrombocytopenia during Pregnancy: A Retrospective Study in a Tertiary Critical Maternity Referral Center

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