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Nationwide Study of Idiopathic Thrombocytopenic Purpura in Pregnant Women and the Clinical Influence on Neonates

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Abstract

Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women during the reproductive years. To obtain information for management of ITP in pregnancy, we performed a nationwide retrospective survey. Findings from a total of 284 pregnant women with ITP and their 286 newborn infants were available for analysis. The bleeding tendency at delivery was managed chiefly with corticosteroid, intravenous high-dose γulin, and platelet transfusion. Maternal complications occurred in 77 cases (27.1%) and were frequently seen in cases with poor control of ITP. Neonatal abnormalities, which were not influenced by the clinical state of the mother, occurred at a frequency of 17.8%. Thrombocytopenia in neonates occurred in 48 cases (22.4%), and bleeding tendency was found in 16 cases (6.3%) without severe bleeding. Prediction of thrombocytopenia in neonates was difficult. However, infants from splenectomized mothers with well-controlled ITP showed thrombocytopenia more frequently than those from nonsplenectomized mothers. Mothers treated with steroids at doses greater than 15 mg/day showed a high frequency of maternal complications and fetal abnormal body weight. These observations will be useful in the management of pregnant women with ITP and their infants.

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References

  1. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods or the American Society of Hematology.Blood. 1996;88:3–40.

    PubMed  CAS  Google Scholar 

  2. Cook RL, Miller RC, Katz VL, Cefalo RC. Immune thrombocytopenic purpura in pregnancy: a reappraisal of management.Obstet Gynecol. 1991;78:578–583.

    CAS  PubMed  Google Scholar 

  3. Iyori H, Fujisawa K, Akatsuka J. Thrombocytopenia in neonates born to women with autoimmune thrombocytopenic purpura.Pediatric Hematol Oncol. 1997;14:367–373.

    Article  CAS  Google Scholar 

  4. Tampakoudis P, Bili H, Lazaridis E, Anastasiadou E, Andreou A, Mantalenakins S. Prenatal diagnosis of intracranial hemorrhage secondary to maternal idiopathic thrombocytopenic purpura: a case report.Am J Perinatol. 1995;12:268–270.

    Article  CAS  PubMed  Google Scholar 

  5. Kelton JG. Thrombocytopenia in pregnancy. In: Schechter G P, Hoffman R, Schrirer SL, eds.Hematology 1999: American Society of Hematology Education Program Book. Washington, DC:American Society of Hematology; 1999:490–497.

    Google Scholar 

  6. Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy.Semin Hematol. 2000;37:275–289.

    Article  CAS  PubMed  Google Scholar 

  7. Kaplan C, Daffos F, Forestier F, et al. Fetal platelet counts in thrombocytopenic pregnancy.Lancet. 1990;336:979–982.

    Article  PubMed  CAS  Google Scholar 

  8. Scioscia AL, Grannum PA, Copel JA, Hobbins JC. The use of percutaneous umbilical blood sampling in immune thrombocytopenic purpura.Am J Obstet Gynecol. 1988;159:1066–1068.

    Article  CAS  PubMed  Google Scholar 

  9. Daffos F, Capella-Pavlovsky M, Forestier F. Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases.Am J Obstet Gynecol. 1985;153: 655–660.

    Article  PubMed  CAS  Google Scholar 

  10. Letsky EA, Greaves M. Guideline: guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia.Br J Haematol. 1996;95:21–26.

    PubMed  CAS  Google Scholar 

  11. Kelton JG. Management of the pregnant patient with idiopathic thrombocytopenic purpura.Ann Intern Med. 1983;99:796–800.

    Article  PubMed  CAS  Google Scholar 

  12. Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries.Am J Obstet Gynecol. 1990;162: 731–734.

    Article  PubMed  CAS  Google Scholar 

  13. McCrae KR, Samuels P, Schreiber AD. Pregnancy-associated thrombocytopenia: pathogenesis and management.Blood. 1992;80: 2697–2714.

    PubMed  CAS  Google Scholar 

  14. Aster RH. “Gestational”rombocytopenia: a plea for conservative management.N Engl J Med. 1990;323:264–266.

    Article  PubMed  CAS  Google Scholar 

  15. Hohlfeld P, Forestier F, Kaplan C, Tissot JD, Daffos F. Fetal thrombocytopenia: a retrospective survey of 5,194 fetal blood samplings.Blood. 1994;84:1851–1856.

    PubMed  CAS  Google Scholar 

  16. Ostesen M. Optimisation of antirheumatic drug treatment in pregnancy.Clin Pharmacokinet. 1994;27:486–503.

    Article  PubMed  CAS  Google Scholar 

  17. Sainio S, Joutsi L, Jarvenpaa AL, et al. Idiopathic thrombocy-topenic purpura in pregnancy.Acta Obstet Gynecol Scand. 1998;77: 272–277.

    Article  PubMed  CAS  Google Scholar 

  18. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia.N Engl J Med. 1993;329:1463–1466.

    Article  PubMed  CAS  Google Scholar 

  19. Samuels P, Bussel JB, Braitman LE, et al. Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura.N Engl J Med. 1990; 323:229–235.

    Article  CAS  PubMed  Google Scholar 

  20. Valat AS, Caulier MT, Devos P, et al. Relationships between severe neonatal thrombocytopenia and maternal characteristics in pregnancies associated with autoimmune thrombocytopenia.Br J Haematol. 1998;103:397–401.

    Article  PubMed  CAS  Google Scholar 

  21. Sharon R, Tatarsky I. Low fetal morbidity in pregnancy associated with acute and chronic idiopathic thrombocytopenic purpura.Am J Hematol. 1994;46:87–90.

    Article  PubMed  CAS  Google Scholar 

  22. Yamada H, Kato EH, Kobashi G, et al. Passive immune thrombocytopenia in neonates of mothers with idiopathic thrombocytopenic purpura: incidence and risk factors.Semin Thromb Hemost. 1999;25:491–496.

    Article  PubMed  CAS  Google Scholar 

  23. Tchernia G, Morel-Kopp MC, Yvart J, Kaplan C. Neonatal thrombocytopenia and hidden maternal autoimmunity.Br J Haematol. 1993;84:457–463.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Pharmaceutical Science, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, 734-8551, Minami-ku,Hiroshima, Japan

    Kingo Fujimura & Tetsuro Fujimoto

  2. Department of Hematology/Oncology ,Research Institute for Radiation Biology and Medicin, Hiroshima University, Hiroshima

    Yuka Harada & Atsushi Kuramoto

  3. Department of Internal Medicine, Keio University School of Medicine, Tokyo

    Yasuo Ikeda

  4. Department of Pediatrics, The Jikei University School of Medicine, Tokyo

    Jun-ichi Akatsuka

  5. Department of Clinical Hematology, Nippon Medical School, Tokyo

    Kazuo Dan

  6. Division of Hematology, Showa University Fujogaoka Hospital, Yokohama

    Mitsuhiro Omine

  7. Department of Hematology, Tokyo Women’s Medical University School, Tokyo, Japan

    Hideaki Mizoguchi

Authors
  1. Kingo Fujimura
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  2. Yuka Harada
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  3. Tetsuro Fujimoto
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  4. Atsushi Kuramoto
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  5. Yasuo Ikeda
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  6. Jun-ichi Akatsuka
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  7. Kazuo Dan
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  8. Mitsuhiro Omine
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  9. Hideaki Mizoguchi
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Corresponding author

Correspondence to Tetsuro Fujimoto.

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Fujimura, K., Harada, Y., Fujimoto, T. et al. Nationwide Study of Idiopathic Thrombocytopenic Purpura in Pregnant Women and the Clinical Influence on Neonates. Int J Hematol 75, 426–433 (2002). https://doi.org/10.1007/BF02982137

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  • DOI: https://doi.org/10.1007/BF02982137

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