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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This study aimed to determine the incidence of severe ITP in pregnancy in the United Kingdom, as well as current management strategies and maternal and fetal outcomes.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research
Publication date: Available online 6 February 2019Source: Best Practice &Research Clinical Obstetrics &GynaecologyAuthor(s): Dian Winkelhorst, Dick OepkesAbstractFoetal or neonatal thrombocytopenia results from alloimmunisation during pregnancy. Maternal alloantibodies can be formed following exposure to paternally derived human platelet antigens (HPAs) on foetal platelets, in case of incompatible HPA type. These alloantibodies are of the immunoglobulin G subclass and can therefore enter the foetal circulation through active placental transport mediated by the neonatal Fc-receptor. After entering the foetal circula...
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research
Publication date: Available online 6 February 2019Source: Best Practice &Research Clinical Obstetrics &GynaecologyAuthor(s): Dian Winkelhorst, Dick OepkesAbstractFetal or neonatal thrombocytopenia results from alloimmunisation during pregnancy. Maternal alloantibodies can be formed following exposure to paternally derived human platelet antigens (HPA) on fetal platelets, in case of incompatible HPA type. These alloantibodies are of the immunoglobulin G subclass and can therefore enter the fetal circulation via active placental transport mediated by the neonatal Fc-receptor. After entering the fetal circulation, the...
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research
We present the case of a 23-year-old pregnant woman with a history of Langerhans cell histiocytosis of the mandible submitted to surgery and chemotherapy when she was 10 years old, with diagnosis of ITP since then. At 28 weeks of gestation, she presented with petechiae, epistaxis, and gingival bleeding, with a platelet count of 3 x 109/L and positive IgG antiplatelet antibodies test. At a multidisciplinary discussion, it was decided to delay a cesarean section, due to the absence of fetal distress and to the high risk of morbidity for the patient. Many therapies were attempted without success. The IgG produced a slight and...
Source: Revista Brasileira de Ginecologia e Obstetricia - Category: OBGYN Source Type: research
Authors: Darmawan G, Hamijoyo L, Oehadian A, Bandiara R, Amalia L Abstract A 38-year-old woman presented with general weakness and vaginal bleeding. One month prior, she had been diagnosed with Evans syndrome (haemolytic anemia with positive Coombs test and thrombocytopenia) and was given oral steroid as maintenance therapy. Her serology examination was negative for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV). Her obstetrical history was marked by miscarriage in second pregnancy and preeclampsia in third pregnancy. She used hormonal contraceptives until 5 months prior to admission. On physical ...
Source: Acta medica Indonesiana - Category: Internal Medicine Tags: Acta Med Indones Source Type: research
ConclusionsThe intent of this guidance document developed from systematic reviews is to promote best practices in the management of FNAIT. The guideline development group developed algorithms for treatment, podcasts for physicians and patients, pamphlets for patients and a slide set to assist with the implementation of recommendations into practice. This expert panel identified key areas for future research. One is the optimal approach to antenatal management of the next affected pregnancy. Developing biomarkers of fetal severity would be critical to this endeavor. In addition, creating comprehensive screening to identify ...
Source: Blood - Category: Hematology Authors: Tags: 901. Health Services Research-Non-Malignant Conditions: Poster III Source Type: research
Introduction. Children diagnosed with Immune thrombocytopenia (ITP) will develop a chronic disease (plt 12 months since the onset) in 20-30% of cases. The transition from ITP started in childhood to adulthood has been scarcely studied and no specific studies have been publishedAims.To present the results of a single center retrospective survey on ITP pts diagnosed in childhood who were sent in an adult setting to continue the managementMethods. Charts of ITP pts diagnosed in childhood (1-17 yrs) in our Pediatric Dept who developed a chronic disease, need at least one line of therapy and were sent to our adult ITP office fr...
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function Source Type: research
Discussion: The expectation for these 17 very difficult to treat pts was that they would have all relapsed in 1 year or less following a "routine" ritux re-induction based on past data and clinical experience. The number of pts reported who achieved lasting remission following a second or third course of ritux is very small. Dex was added to reinduction in 5 of these multiply-induced pts, but curative effects occur only in female pts treated within 1 year of diagnosis, and these were pts with years of disease so this would not explain the results. Being able to achieve lasting remission over many years in half th...
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function: Poster III Source Type: research
Background: Eltrombopag is an oral thrombopoietin receptor agonist that has been licensed for use as second line therapy in ITP patients. For most subjects, platelet counts usually return to baseline within 2 weeks of eltrombopag discontinuation, however, up to 15% of subjects may maintain a prolonged response after discontinuation (BJH Volume 165(6) 2014 865-869). Therefore, we conducted a pilot study to evaluate whether a 12-week course of eltrombopag plus pulsed dexamethasone as first line therapy can increase the proportion of patients with prolonged response.Methods: This multicenter, single arm, open-label pilot stud...
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function: Advances in the Treatment of ITP Source Type: research
BackgroundPatients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolism related to different causes, including the use of thrombopoietin receptor agonists and splenectomy. Patients with ITP who develop coronary artery disease (CAD) can be a further challenge given their risk of both thromboembolism and bleeding, which may significantly increase the risk of mortality and length of stay (LOS) compared to patients who do not have ITP. We aimed to study the impact of ITP in hospital outcomes of patients with CAD.MethodsWe utilized the National Inpatient Sample database from years 2009 - 2011. We selec...
Source: Blood - Category: Hematology Authors: Tags: 903. Outcomes Research-Non-Malignant Hematology Source Type: research
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