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International Journal of Hematology

, Volume 75, Issue 4, pp 426–433 | Cite as

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

  • Kingo Fujimura
  • Yuka Harada
  • Tetsuro Fujimoto
  • Atsushi Kuramoto
  • Yasuo Ikeda
  • Jun-ichi Akatsuka
  • Kazuo Dan
  • Mitsuhiro Omine
  • Hideaki Mizoguchi
Case Report

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.

Key words

ITP Pregnancy Maternal complication Fetal thrombocytopenia Corticosteroid treatment 

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References

  1. 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.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Cook RL, Miller RC, Katz VL, Cefalo RC. Immune thrombocytopenic purpura in pregnancy: a reappraisal of management.Obstet Gynecol. 1991;78:578–583.Google Scholar
  3. 3.
    Iyori H, Fujisawa K, Akatsuka J. Thrombocytopenia in neonates born to women with autoimmune thrombocytopenic purpura.Pediatric Hematol Oncol. 1997;14:367–373.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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. 6.
    Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy.Semin Hematol. 2000;37:275–289.CrossRefGoogle Scholar
  7. 7.
    Kaplan C, Daffos F, Forestier F, et al. Fetal platelet counts in thrombocytopenic pregnancy.Lancet. 1990;336:979–982.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 11.
    Kelton JG. Management of the pregnant patient with idiopathic thrombocytopenic purpura.Ann Intern Med. 1983;99:796–800.CrossRefPubMedGoogle Scholar
  12. 12.
    Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries.Am J Obstet Gynecol. 1990;162: 731–734.CrossRefPubMedGoogle Scholar
  13. 13.
    McCrae KR, Samuels P, Schreiber AD. Pregnancy-associated thrombocytopenia: pathogenesis and management.Blood. 1992;80: 2697–2714.PubMedGoogle Scholar
  14. 14.
    Aster RH. “Gestational”rombocytopenia: a plea for conservative management.N Engl J Med. 1990;323:264–266.CrossRefPubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 16.
    Ostesen M. Optimisation of antirheumatic drug treatment in pregnancy.Clin Pharmacokinet. 1994;27:486–503.CrossRefPubMedGoogle Scholar
  17. 17.
    Sainio S, Joutsi L, Jarvenpaa AL, et al. Idiopathic thrombocy-topenic purpura in pregnancy.Acta Obstet Gynecol Scand. 1998;77: 272–277.CrossRefPubMedGoogle Scholar
  18. 18.
    Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia.N Engl J Med. 1993;329:1463–1466.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 23.
    Tchernia G, Morel-Kopp MC, Yvart J, Kaplan C. Neonatal thrombocytopenia and hidden maternal autoimmunity.Br J Haematol. 1993;84:457–463.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2002

Authors and Affiliations

  • Kingo Fujimura
    • 1
  • Yuka Harada
    • 2
  • Tetsuro Fujimoto
    • 1
  • Atsushi Kuramoto
    • 2
  • Yasuo Ikeda
    • 3
  • Jun-ichi Akatsuka
    • 4
  • Kazuo Dan
    • 5
  • Mitsuhiro Omine
    • 6
  • Hideaki Mizoguchi
    • 7
  1. 1.Department of Clinical Pharmaceutical ScienceGraduate School of Medicine, Hiroshima UniversityMinami-ku,HiroshimaJapan
  2. 2.Department of Hematology/Oncology ,Research Institute for Radiation Biology and MedicinHiroshima UniversityHiroshima
  3. 3.Department of Internal MedicineKeio University School of MedicineTokyo
  4. 4.Department of PediatricsThe Jikei University School of MedicineTokyo
  5. 5.Department of Clinical HematologyNippon Medical SchoolTokyo
  6. 6.Division of HematologyShowa University Fujogaoka HospitalYokohama
  7. 7.Department of HematologyTokyo Women’s Medical University SchoolTokyoJapan

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