Successful Treatment of a Steroid-Resistant Form of Idiopathic Thrombocytopenic Purpura in Pregnancy with High Doses of Intravenous Immunoglobulins

Fabris, P; Quaini, R; Coser, P; Casini, Marco; Franceschini, Isabelle; Pianezze, Graziano

doi:10.1159/000205968

Cited by 10 publications

(2 citation statements)

References 15 publications

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“…While data on the use of this medication during pregnancy are limited, there have been several case reports suggesting safety of IVIG during pregnancy [ 66 ]. Moreover, this medication has also been used to manage refractory obstetric complications of the antiphospholipid antibody syndrome without inducing congenital malformations [ 67 ].…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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Congenital anomalies occur in 3 % of normal pregnancies [ 1 ]. Therefore, risk assessment of any particular agent during pregnancy needs to take into account this background rate of teratogenicity. For many years, clinicians relied on the FDA risk categories (A, B, C, D, and X) to assess drugs for safety for use in pregnancy. As Briggs, author of the major textbook in this fi eld, points out, these risk assessments are limited because they are "confusing and simplistic" and incorrectly gave the impression that risk increases from category to category [ 2 ]. The FDA is currently considering new labeling for pregnancy risk. The approach this chapter will take is to present the available data on medication safety in pregnancy and lactation and to synthesize the information regarding drug safety.Each pregnant woman has her own view about assuming risk during her pregnancy. For example, some women will avoid any substance that could have potential risk during pregnancy (caffeine, over-the-counter medications, food-additives) while other women will be willing to assume some risk and modify their ingestion of these substances. Similarly, treating physicians have varying tolerance to risk. While one clinician may be willing to prescribe TNF-α blockers during pregnancy, others will be uncomfortable recommending these medications. Therefore, when approaching management decisions of rheumatic diseases during pregnancy, it is helpful for the treating clinician to be aware of both the patient's and their own risk tolerance, in addition to the available medical data. To this end, up-front discussions prior to conception or early in pregnancy regarding what medications may be used safely and comfortably in the case of a disease fl are are ideal.

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Section: Intravenous Immunoglobulinmentioning

confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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“…29 If platelet levels fall below 50 x KM" 1 , oral steroids and/or intravenous immunoglobulins will improve the count in at least 70% of cases. 13 -46 - 62 On cost grounds, steroids should perhaps be employed first 67 and immunoglobulins reserved for steroid-resistant cases. If immunoglobulin infusions are used, treatment should start some fourteen days before elective delivery, since this would appear to be the optimal interval for maximal response.…”

Section: Discussionmentioning

confidence: 99%

Immune thrombocytopenia in pregnancy

Browning¹,

James²

1990

Fet. Matern. Med. Rev.

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Autoimmune thrombocytopenia (ITP)1) The risks to mother and fetus have previously been overstated.2) There is no maternal test which will accurately determine fetal thrombocytopenia.3) The only reliable test for fetal thrombocytopenia is cordocentesis – this carries a higher morbidity than that of fetal intracerebral haemorrhage from ITP.4) Contrary to received wisdom, there is no evidence that, even for the most severely thrombocytopenic infant, abdominal delivery protects against intracranial haemorrhage.5) Management therefore involves keeping the maternal platelet count above 50 × 1091 and choosing the route of delivery on normal obstetric grounds.Alloimmune thrombocytopenia1) Alloimmune thrombocytopenia is commoner than hitherto believed (0.15% all neonates).2) The fetal risks are considerable: intracranial haemorrhage occurs in 4% of cases antenatally and in 10% in labour. The risks are virtually confined to those with a platelet count of less than 30 × 109l−1.3) Cordocentesis is justified for the ‘at risk’ fetus; fetal immunoglobulin or platelet therapy can be given.4) When the fetal platelet count is below 50 × 109l−1, abdominal delivery should be planned.5) A maternal screening test for neonatal alloimmune thrombocytopenia exists (lack of P1A1 antigen).

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