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Efficacy of treatment immune thrombocytopenic purpura in pregnancy with corticosteroids and intravenous immunoglobulin: a prospective follow-up of suggested practice

The current study is performed to assess a routine for treatment of immune thrombocytopenic purpura in pregnancy. A prospective programme for monitoring and treatment with intravenous immunoglobulin or cortisone in pregnancies with immune thrombocytopenic purpura was suggested to all delivery units in Sweden. Treatment should be avoided if platelet counts were more than 20 × 109/l during pregnancy with no bleeding complications and with a target of 100 × 109/l at delivery. Descriptive statistics and logistic regression analysis were used. Seventy-five pregnancies were followed; treatment was given in 29 (39%) of the pregnancies; in 13 intravenous immunoglobulin, in six cortisone, in nine a combination of both immunoglobulin and cortisone and in one platelets was given. The mean platelet increase before delivery after immunoglobulin was 46 × 109/l approximately 3 days later. At delivery, 34 (45%) of all pregnancies reached target platelet level more than 100 × 109/l, whereas five (7%) had platelets less than 50 × 109/l. Mode of delivery and blood loss were similar to a reference group. Of the neonates, 23% had platelets less than 50 × 109/l with a nadir reached on day 2–4; 9% required treatment. Women with platelets less than 20 × 109/l in pregnancy or with prior neonatal thrombocytopenia were at a, respectively, five-fold and eight-fold increased risk of neonatal thrombocytopenia. A routine to avoid t...
Source: Blood Coagulation and Fibrinolysis - Category: Hematology Tags: Original Articles Source Type: research

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Type 2B von Willebrand disease (VWD) is an inherited bleeding disorder caused by changes in von Willebrand factor (VWF) that enhance binding of VWF to GPIb on platelets. Although this disorder is seemingly well defined because of this single molecular defect, in reality type 2B VWD is a clinically heterogeneous disorder that can be difficult to identify and manage. Diagnostic criteria include a history of mucocutaneous bleeding, laboratory studies showing enhanced VWF binding of platelets and/or a 2B VWD genetic variant, and a family history consistent with autosomal dominant inheritance. Thrombocytopenia, although not alw...
Source: Blood - Category: Hematology Authors: Tags: How I Treat, Free Research Articles, Thrombosis and Hemostasis Source Type: research
This study accessed the patients information on demographic characteristics, physical signs and symptoms. Study population This is a cross-sectional and observational study carried out in Brazil during DENV and ZIKV epidemic occurred in 2016. Patients were assisted at the Healthy Unit UPA Coronel Antonino in Campo Grande, MS, Brazil from February to March of 2016. During the study 134 suspected arboviral infection cases were included and submitted to investigation. Patients presenting fever, rash during acute phase of infection (up to the 7th day after disease onset) followed by at least two of the following signals a...
Source: PLOS Currents Outbreaks - Category: Epidemiology Authors: Source Type: research
A 36-yr-old woman, G5P2, who had a background history of systemic lupus erythematosus (SLE) was found to have placenta previa and placenta accreta on second trimester ultrasound scan. She had previous 3 spontaneous miscarriages but there was no history of gynecologic interventions. Apart from SLE, there was no other explanation for her recurrent miscarriage. The patient had ongoing thrombocytopenia in this pregnancy. The patient was taken for elective lower uterine segment cesarean section at 36 wk+5 d gestation. Balloon catheters were placed in the anterior branches of the internal iliac arteries before the operation. Des...
Source: International Journal of Gynecological Pathology - Category: Pathology Tags: Pathology of the Corpus: Case Report Source Type: research
We report here the first successful cesarean delivery of a woman with MYH9-RD treated with eltrombopag during the last month of pregnancy.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research
Editor —Immune thrombocytopenia (ITP) is an autoimmune condition affecting 1–10 in 10 000 pregnancies.1 The bleeding risk associated with significant thrombocytopenia poses a challenge peripartum, particularly for placement of neuraxial anaesthesia, where evidence to guide practice remains scant.2 Our aim is to describe our experience with neuraxial anaesthesia in the setting of ITP in pregnancy at two tertiary-level academic institutions. The report is a secondary analysis of a retrospective study of pregnant women with ITP at two tertiary-level Canadian academic institutions: Mount Sinai Hospital (MSH)...
Source: British Journal of Anaesthesia - Category: Anesthesiology Source Type: research
Opinion statementThrombotic complications in pregnancy represent a major cause of morbidity and mortality. Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis. These physiologic changes will yield a collective rate of venous thromboembolism (VTE) of about 1 –2 in 1000 pregnancies for the general obstetric population, which represents a five- to tenfold increased risk in pregnancy compared to age-matched non-pregnant peers. A select group of women, however, will carry a significantly higher rate of thrombosis due ...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but potentially very serious bleeding condition affecting the fetus/newborn. The vast majority (>80%) of FNAIT cases among Caucasians, and the most serious one, are caused by maternal antibodies to the human platelet antigen 1a (HPA‐1a). The clinical consequences of FNAIT span a continuum from no symptoms to intracranial haemorrhage (ICH) and intrauterine death. The incidence of FNAIT‐associated ICH has been estimated to be around 1 in 10 000 newborns. For many reasons, FNAIT has not been considered for prophylactic efforts similar to those that have b...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Congress Review Source Type: research
In conclusion, rhTPO is a potentially safe and effective treatment choice for patients with ITP during pregnancy. Our work has paved the way for further study on the clinical application of rhTPO and other thrombopoietic agents for the management of ITP during pregnancy. This study is registered at www.clinicaltrials.gov as NCT02391272.
Source: Blood - Category: Hematology Authors: Tags: Thrombocytopenia, Free Research Articles, Platelets and Thrombopoiesis, Clinical Trials and Observations Source Type: research
ObjectiveTo quantify the incidence of severe autoimmune thrombocytopenia (ITP) in pregnancy in the UK, determine current treatment strategies, and establish maternal and neonatal morbidity and mortality associated with severe ITP in pregnancy. DesignA prospective national cohort study. SettingUK. PopulationWomen with severe ITP, defined as platelets
Source: BJOG: An International Journal of Obstetrics and Gynaecology - Category: OBGYN Authors: Tags: Original Article Source Type: research
This article is protected by copyright. All rights reserved. PMID: 28724194 [PubMed - as supplied by publisher]
Source: BJOG : An International Journal of Obstetrics and Gynaecology - Category: OBGYN Authors: Tags: BJOG Source Type: research
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