Managing ITP and thrombocytopenia in pregnancy.

Managing ITP and thrombocytopenia in pregnancy. Platelets. 2019 Jul 11;:1-7 Authors: Eslick R, McLintock C Abstract Around 1 in 10 pregnant women will develop thrombocytopenia during an otherwise unremarkable pregnancy. While the most frequent cause is gestational thrombocytopenia, a benign clinical entity which typically induces a mild platelet fall in late pregnancy, a number of important pregnancy-specific causes must be excluded, particularly pre-eclampsia and its severe form hemolysis with elevated liver enzymes and low platelets (HELLP). For women who do not have an identifiable pregnancy-related cause of thrombocytopenia, an underlying medical condition should be considered. The most common of these is immune thrombocytopenia (ITP). Management of ITP in pregnancy can prove particularly challenging. First-line treatment options are limited to intravenous immunoglobulin or corticosteroids; with a higher rate of adverse effects and a lower likelihood of response than in the non-pregnant population. The safety data for commonly employed second-line treatment options is scarce, and there is no international consensus on the optimal second-line treatment in pregnancy. Management of ITP is further complicated by the desire to attain higher platelet thresholds to facilitate the safe administration of neuraxial anesthesia and minimize the risk of postpartum hemorrhage. Finally, the risk of neonatal thrombocytopenia must be considered and appropriate precaut...
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research

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We present a case of MAP complicating a dichorionic diamniotic (DCDA) twin pregnancy requiring delivery by emergency cesarean hysterectomy at 30 + 2 weeks of gestation.Case PresentationA 36-year-old woman, G3P2, with a DCDA twin pregnancy and known MAP presented to the labour ward at 30 + 2 weeks of gestation with evidence of pre-eclampsia and fulminating HELLP syndrome. Delivery was indicated due to fetal distress, demonstrated by pathological findings on cardiotocography, acutely deranged liver functions and worsening thrombocytopenia. An emergency cesarean hysterectomy was performed with postoperative monito...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
Conditions:   Pre-Eclampsia;   Hypertension;   Proteinuria in Pregnancy;   Thrombocytopenia;   Renal Insufficiency;   Impaired Liver Function;   Pulmonary Edema;   Headache;   Visual Impairment Intervention:   Other: Non-interventional study Sponsor:   Progenity, Inc. Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Complement-mediated thrombotic microangiopathy (TMA), also known as atypical hemolytic uremic syndrome (aHUS) is a rare, hereditary, progressive, life-threatening disorder caused by a disruption in regulation of the alternative pathway of the complement system. Eculizumab, a terminal complement inhibitor, has emerged as a first-line therapy, however data are limited to small case series (Brocklebank et al., 2017). Here, we present a diagnostically challenging case of complement-mediated TMA, who received eculizumab therapy with excellent hematologic response.A 68-year-old female with history of possible Sjogren's syndrome,...
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function Source Type: research
ConclusionRCE was well-tolerated and associated with good and possibly improved maternal and fetal outcomes in this small cohort of sickle cell patients. Larger studies are required to further characterise the benefit of prophylactic RCE during pregnancy in the SCD population.DisclosuresSzer: Alexion Pharmaceuticals, Inc.: Consultancy, Honoraria, Other: Travel Support , Research Funding.
Source: Blood - Category: Hematology Authors: Tags: 114. Hemoglobinopathies, Excluding Thalassemia-Clinical Source Type: research
​BY GREGORY TAYLOR, DO, &SHERIF G. EL-ALAYLI, DOA 30-year-old G5P3 presented to the ED with bilateral lower-extremity edema and headache for three days. She presented one week after an uncomplicated full-term vaginal delivery with an unremarkable pregnancy course and no prior requirement for antihypertensive therapy. The headache was described as achy to sharp, with associated photophobia. She also noted occasional vaginal spotting, which was common a few weeks after delivery. She denied any chest pain, shortness of breath, nausea or vomiting, abdominal pain, or any other symptoms. She admitted to occasional mild cra...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
We present a teaching case of atypical hemolytic uremic syndrome in the postpartum period in a young woman who was found to have mutations of uncertain clinical significance in the complement cascade, including in C3, CFH, and CFI. We use this as an opportunity to review the clinical presentation and pathophysiology of preeclampsia, eclampsia, and the TMAs. We focus on diagnostic challenges, especially because many patients with TMA do not present with thrombocytopenia, which can delay diagnosis. We additionally review the clinical settings in which administration of eculizumab, a C5 membrane attack complex inhibitor, is appropriate.
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
Publication date: Available online 20 March 2018 Source:The Lancet Global Health Author(s): Jahnavi Daru, Javier Zamora, Borja M Fernández-Félix, Joshua Vogel, Olufemi T Oladapo, Naho Morisaki, Özge Tunçalp, Maria Regina Torloni, Suneeta Mittal, Kapila Jayaratne, Pisake Lumbiganon, Ganchimeg Togoobaatar, Shakila Thangaratinam, Khalid S Khan Background Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and m...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research
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