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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Inherited platelet disorders : Management of the bleeding risk. Transfus Clin Biol. 2018 Aug 01;: Authors: Dupuis A, Gachet C Abstract Inherited platelet disorders are rare bleeding syndromes due to either platelet function abnormalities or thrombocytopenia which may be associated with functional defects. The haemorrhagic symptoms observed in these patients are mostly muco-cutaneous and of highly variable severity. Although 30 to 50% of the platelet disorders are still of unknown origin, the precise diagnosis of these pathologies by specialized laboratories together with haemorrhagic scores enabl...
Source: Transfusion Clinique et Biologique - Category: Hematology Authors: Tags: Transfus Clin Biol Source Type: research
AbstractPurpose of reviewThis manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment.Recent findingsThe obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted.SummaryVTE during pregnancy and the postpartum window occurs at a 6 –10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoag...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 010 Peer Reviewer: Dr Jennifer Ho, ID physician QLD, Australia You are an ED doc working in Perth over schoolies week. An 18 yo man comes into ED complaining of fever, rash a “cracking headache” and body aches. He has just hopped off the plane from Bali where he spent the last 2 weeks partying, boozing and running amok. He got bitten by “loads” of mosquitoes because he forgot to take insect repellent. On e...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine arthralgia dengue fever rash Source Type: blogs
During pregnancy the physiological changes in the haemostatic system tend to improve mild inherited bleeding disorders. However, thrombocytopenia and coagulation problems unique to pregnancy may occur. In this review, we discuss and provide recommendations for the management of bleeding problems seen in pregnancy, such as thrombocytopenia, von Willebrand disease, haemophilias and thrombotic microangiopathies. In the majority of cases complicated by haematological disease, pregnancy, delivery, and the puerperium should be managed by a multidisciplinary team, which includes obstetricians, haematologists and obstetric anaesthetists.
Source: Obstetrics, Gynaecology and Reproductive Medicine - Category: OBGYN Authors: Tags: Review Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0038-1648233Glanzmann's thrombasthenia (GT) and Bernard–Soulier's syndrome (BSS) are well-understood congenital bleeding disorders, showing defect/deficiency of platelet glycoprotein (GP) IIb/IIIa (integrin αIIbβ3) and GPIb-IX-V complexes respectively, with relevant clinical, laboratory, biochemical, and genetic features. Following platelet transfusion, affected patients may develop antiplatelet antibodies (to human leukocyte antigen [HLA], and/or αIIbβ3 in GT or GPIb-IX in BSS), which may render future platelet transfusion ineffective. Anti-αIIbβ3 a...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Review Article Source Type: research
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
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