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Managing ITP and thrombocytopenia in pregnancy.

Authors
  • Eslick, Renee1
  • McLintock, Claire2
  • 1 Clinical and Laboratory Haematologist, Haematology Department, Liverpool Hospital, University of New South Wales, Sydney, Australia. , (Australia)
  • 2 Clinical and Laboratory Haematologist, Obstetric Physician, National Women's Health, Auckland City Hospital, Auckland, New Zealand. , (New Zealand)
Type
Published Article
Journal
Platelets
Publisher
Informa UK (Taylor & Francis)
Publication Date
Jan 01, 2020
Volume
31
Issue
3
Pages
300–306
Identifiers
DOI: 10.1080/09537104.2019.1640870
PMID: 31296105
Source
Medline
Keywords
Language
English
License
Unknown

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 precautions taken at the time of delivery.

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