The presentation and management of platelet disorders in pregnancy

Goldman, Bernardus G.; Hehir, Mark P.; Yambasu, Sahr; O'Donnell, Edward

doi:10.1111/ejh.13049

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…Antiphospholipid antibodies and platelet antibodies are some of the main autoantibodies described in relation to autoimmune disorders, which may present with thrombosis and/or bleeding symptoms (e.g. antiphospholipid syndrome and idiopathic (or immune) thrombocytopenic purpura) [ 62 , 63 ]. A possible overlap between these autoimmune disorders and autoantibodies with autoimmune thyroid diseases is an interesting pathophysiological thought and a relevant topic for future research.…”

Section: Thyroid Disease and Vte In Non-pregnant Individualsmentioning

confidence: 99%

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

2021

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Pregnancy induces physiological changes that affect the risk of thrombosis and thyroid disease. In this hypothesis-generating review, the physiological changes in the coagulation system and in thyroid function during a normal pregnancy are described, and the incidence of venous thromboembolism (VTE) and thyroid disease in and after a pregnancy are compared and discussed. Furthermore, evidence regarding the association between thyroid disease and VTE in non-pregnant individuals is scrutinized. In conclusion, a normal pregnancy entails hormonal changes, which influence the onset of VTE and thyroid disease. Current evidence suggests an association between thyroid disease and VTE in non-pregnant individuals. This review proposes the hypothesis that maternal thyroid disease associates with VTE in pregnant women and call for future research studies on this subject. If an association exists in pregnant women specifically, such findings may have clinical implications regarding strategies for thyroid function testing and potential thromboprophylaxis in selected individuals.

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Section: Thyroid Disease and Vte In Non-pregnant Individualsmentioning

confidence: 99%

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

2021

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“…Neonatal thrombocytopenia occurs at a rate of 10 to 15%, with platelet counts as low as 20 Â 10 9 /L in 5% of these highrisk infants, regardless of the severity of maternal thrombocytopenia. 127 It has generally been ascertained that neonatal outcomes are independent of maternal thrombocytopenia in ITP, and that the presence of neonatal thrombocytopenia is more common when prematurity is implicated. 125 The onset of thrombocytopenia due to maternal antiplatelet IgG may be delayed up to the first week postpartum.…”

Section: Maternal-fetal Quantitative Platelet Defectsmentioning

confidence: 99%

High-Risk Pregnancies and Their Impact on Neonatal Primary Hemostasis

Politou

Mougiou

Kollia

et al. 2019

Semin Thromb Hemost

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Primary hemostasis, similar to other systems in the adjusting and transitioning neonate, undergoes developmental adaptations in the first days of life. Although platelets of neonates do not differ quantitatively compared with those of adults, they functionally present with major differences, thus supporting the theory of a “hypofunctional” phenotype that is counterbalanced by high hematocrit and more potent von Willebrand factor multimers. No clinical effect of bleeding tendency has hence been established so far for healthy term neonates. However, discrepancies in functionality have been noted, associated with gestational age, with more pronounced platelet hyporesponsiveness in preterm neonates. Multiple methods of in vitro platelet function evaluation such as PFA-100/200, platelet aggregometry, flow cytometry, and cone and platelet analyzer have been used for assessment of neonatal primary hemostasis. Several pregnancies are characterized as “high-risk” when risk factors preexist in maternal history or evolve during pregnancy. These pregnancies require specialized observation as they may have unpredictable outcome. High-risk pregnancies include clinical entities such as preeclampsia, pregnancy-induced smoking during pregnancy, gestational diabetes mellitus (GDM), autoimmune diseases, and other maternal hematological conditions. In some cases, like systemic lupus erythematosus, antiphospholipid antibody syndrome, and maternal immunologically based thrombocytopenia, neonatal thrombocytopenia is regarded as a prominent hemostasis defect, while in others, like pregnancy-induced hypertension and preeclampsia, both quantitative and qualitative disorders of neonatal platelets have been reported. In other pathologies, like GDM, neonatal primary hemostasis remains vastly unexplored, which raises the need for further investigation. The extent to which primary hemostasis is affected in neonates of high-risk pregnancies is the main objective of this narrative review.

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“…Thrombocytopenia can occur through different mechanisms such as the lowering of platelet production, an increase in their destruction or other causes such as splenic sequestration or dilution (Table 1). Regardless of the cause, thrombocytopenia can be found in between 7% and 12% of pregnant patients 3,4 . Thrombocytopenia is the second most frequent anomaly in a complete blood cell count during pregnancy, after anemia.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 8% of women can develop mild thrombocytopenia (100,000/µl-150,000/µl) during pregnancy, from which 65% will not have a precipitating pathology 5,6 . Nevertheless, in all patients with a platelet count under 100,000/µl, the cause, which may or may not be linked to pregnancy, ought to be found 4,7,8 (Table 2).…”

Section: Introductionmentioning

confidence: 99%

Differential diagnosis of thrombocytopenia in pregnancy

Gutiérrez-Aguirre¹,

Esparza-Sandoval²

2019

RMU

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Thrombocytopenia is encountered in 7-12% of all pregnancies and is the second most common abnormality of the complete blood count after anemia. The most important causes of thrombocytopenia during pregnancy are gestational thrombocytopenia, accounting for 60-75% of the cases, which usually poses no risk to either the mother or the product and no treatment is necessary. Furthermore, thrombocytopenia associated with pre-eclampsia, eclampsia, or hemolysis, elevated liver enzymes, and low platelet syndrome in 21% of the cases, which needs to be detected early due to the urgent medical attention required since the definitive treatment is the delivery of the fetus, and immune thrombocytopenia (ITP) in 3-10% that has a more severe presentation and can trigger maternal and neonatal complications. The differential diagnosis of the thrombocytopenia is highly important, as the complications and required treatment vary from one disease to another, and necessary to improve maternal and neonatal prognosis.

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The presentation and management of platelet disorders in pregnancy

Cited by 18 publications

References 38 publications

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review

High-Risk Pregnancies and Their Impact on Neonatal Primary Hemostasis

Differential diagnosis of thrombocytopenia in pregnancy

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