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Maternale Thrombozytopenie und Thrombozytopathie

Was gilt es in der Schwangerschaft zu beachten?

Maternal thrombocytopaenia and thrombocytopathy

What should be monitored during pregnancy?

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Thrombozytenzahl und -funktion sind nicht nur der in Schwangerschaft eine wichtige Grundlage für eine adäquate Hämostase. Thrombozytopenien jeglicher Ausprägung treten bei bis zu 15% aller Schwangerschaften auf. Die weitaus häufigste Form, die Gestationsthrombozytopenie, ist aufgrund ihres meist milden Verlaufs häufig nur von untergeordneter klinischer Bedeutung. Komplexere Formen eines Plättchenmangels, wie auch die wesentlich seltener auftretenden genuinen Thrombozytopathien, dagegen bedürfen einer risikoadaptierten Überwachung von Gravidität wie Geburtsverlauf und stellen Paradebeispiele einer interdisziplinären Vorgangsweise bei (Hoch-) Risikoschwangeren dar.

Abstract

Sufficient concentration and function of thrombocytes constitute an important part of adequate haemostasis in both pregnant and non-pregnant individuals. Any form of thrombocytopaenia may occur in up to 15% of pregnancies with its most frequent form—gestational thrombocytopaenia—being of rather minor importance due to its mild clinical course. Complex variants of thrombocytopaenia as well as rarely encountered genuine thrombocytopathic diseases, however, require risk-adjusted monitoring both during pregnancy and delivery and constitute a prime example of an interdisciplinary approach for (high) risk patients.

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Literatur

  1. Berndt MC, Andrews RK (2011) Bernard-Soulier syndrome. Haematologica 96:355–359

    Article  PubMed  Google Scholar 

  2. Boehlen F, Hohlfeld P, Extermann P et al (2000) Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 95:29–33

    Article  PubMed  CAS  Google Scholar 

  3. Boehlen F (2006) Thrombocytopenia during pregnancy. Importance, diagnosis and management. Hamostaseologie 26:72–74

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  5. Crowther MA, Burrows RF, Ginsberg J, Kelton JG (1996) Thrombocytopenia in pregnancy: diagnosis, pathogenesis and management. Blood Rev 10:8–16

    Article  PubMed  CAS  Google Scholar 

  6. Dolberg OJ, Ellis M (2011) Successful pregnancy and delivery in a woman with gray platelet syndrome. Isr Med Assoc J 13:117–118

    PubMed  Google Scholar 

  7. Egerman RS, Witlin AG, Friedman SA, Sibai BM (1996) Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome in pregnancy: review of 11 cases. Am J Obstet Gynecol 175:950–956

    Article  PubMed  CAS  Google Scholar 

  8. Esplin MS, Branch DW (1999) Diagnosis and management of thrombotic microangiopathies during pregnancy. Clin Obstet Gynecol 42:360–367

    Article  PubMed  CAS  Google Scholar 

  9. Faridi A, Rath W (2001) Differential diagnosis of thrombocytopenia in pregnancy. Zentralbl Gynakol 123:80–90

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Greaves M, Letsky EA (1997) Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Br J Obstet Gynaecol 104:1108

    Article  PubMed  CAS  Google Scholar 

  12. Jedlitschky G, Cattaneo M, Lubenow LE et al (2010) Role of MRP4 (ABCC4) in platelet adenine nucleotide-storage: evidence from patients with delta-storage pool deficiencies. Am J Pathol 176:1097–1103

    Article  PubMed  CAS  Google Scholar 

  13. Johnson JR, Samuels P (1999) Review of autoimmune thrombocytopenia: pathogenesis, diagnosis, and management in pregnancy. Clin Obstet Gynecol 42:317–326

    Article  PubMed  CAS  Google Scholar 

  14. Kemp WL, Barnard JJ, Prahlow JA (1999) Death due to thrombotic thrombocytopenic purpura in pregnancy: case report with review of thrombotic microangiopathies of pregnancy. Am J Forensic Med Pathol 20:189–198

    Article  PubMed  CAS  Google Scholar 

  15. Kwaan HC, Soff GA (1997) Management of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Semin Hematol 34:159–166

    PubMed  CAS  Google Scholar 

  16. Levy JA, Murphy LD (2002) Thrombocytopenia in pregnancy. J Am Board Fam Pract 15:290–297

    PubMed  Google Scholar 

  17. Magann EF, Martin JN Jr (1999) Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 42:532–550

    Article  PubMed  CAS  Google Scholar 

  18. McCrae KR, Cines DB (1997) Thrombotic microangiopathy during pregnancy. Semin Hematol 34:148–158

    PubMed  CAS  Google Scholar 

  19. McCrae KR, Bussel JB, Mannucci PM et al (2001) Platelets: an update on diagnosis and management of thrombocytopenic disorders. Hematology 2001:282–305

    Article  Google Scholar 

  20. McCrae KR (2010) Thrombocytopenia in pregnancy. Hematology 397–402

  21. McMillan R (2007) The pathogenesis of chronic immune thrombocytopenic purpura. Semin Hematol 44(4 Suppl 5):S3–S11

    Article  PubMed  CAS  Google Scholar 

  22. Michel M, Novoa MV, Bussel JB (2003) Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. Br J Haematol 123:142–146

    Article  PubMed  CAS  Google Scholar 

  23. Mori K, Suzuki S, Sugai K (1984) Electron microscopic and functional studies on platelets in gray platelet syndrome. Tohoku J Exp Med 143:261–287

    Article  PubMed  CAS  Google Scholar 

  24. Nurden P, Jandrot-Perrus M, Combrié R et al (2004) Severe deficiency of glycoprotein VI in a patient with gray platelet syndrome. Blood 104:107–114

    Article  PubMed  CAS  Google Scholar 

  25. Nurden AT, Nurden P (2007) The gray platelet syndrome: clinical spectrum of the disease. Blood Rev 21:21–36

    Article  PubMed  CAS  Google Scholar 

  26. Pajor A, Hintalan A, Bakos L, Lintner F (1993) Postpartum hemolytic uremic syndrome following placental abruption. Eur J Obstet Gynecol Reprod Biol 49:201–204

    Article  PubMed  CAS  Google Scholar 

  27. Poddar RK, Coley S, Pavord S (2004) Hermansky-Pudlak syndrome in a pregnant patient. Br J Anaesth 93:740–742

    Article  PubMed  CAS  Google Scholar 

  28. Provan D, Newland A (2003) Idiopathic thrombocytopenic purpura in adults. J Pediatr Hematol Oncol 25:S34–S38

    Article  PubMed  Google Scholar 

  29. Provan D, Stasi R, Newland AC et al (2010) International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 115:168–186

    Article  PubMed  CAS  Google Scholar 

  30. Ruggenenti P, Remuzzi G (1998) Pathophysiology and management of thrombotic microangiopathies. J Nephrol 11:300–310

    PubMed  CAS  Google Scholar 

  31. Sandrock K, Zieger B (2010) Current Strategies in Diagnosis of Inherited Storage Pool Defects. Transfus Med Hemother 37:248–258

    PubMed  Google Scholar 

  32. Scharf RE (2003) Congenital and acquired thrombocytopenias. Hamostaseologie 23:159–169

    PubMed  CAS  Google Scholar 

  33. Scharf RE (2003) Congenital and acquired platelet function disorders. Hamostaseologie 23:170–180

    PubMed  CAS  Google Scholar 

  34. Scharrer I (2004) Women with von Willebrand disease. Hamostaseologie 24:44–49

    PubMed  CAS  Google Scholar 

  35. Stavrou E, McCrae KR (2009) Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am 23:1299–1316

    Article  PubMed  Google Scholar 

  36. Sullivan CA, Martin JN Jr (1995) Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol 38:521–534

    Article  PubMed  CAS  Google Scholar 

  37. Tanaka M, Balki M, McLeod A, Carvalho JC (2009) Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count. Rev Bras Anestesiol 59:142–153

    Article  PubMed  Google Scholar 

  38. Tsai HM (2010) Pathophysiology of thrombotic thrombocytopenic purpura. Int J Hematol 91:1–19

    Article  PubMed  Google Scholar 

  39. Weiner CP (1987) Thrombotic microangiopathy in pregnancy and the postpartum period. Semin Hematol 24:119–129

    PubMed  CAS  Google Scholar 

  40. Keeney S, Bowen D, Cuming A et al. (2008) The molecular analysis of von Willebrand disease: a guideline from the UK Haemophilia Doctor’s Organisation Haemophilia Genetics Laboratory Network. Haemophilia 14:1099−1111

    Article  PubMed  CAS  Google Scholar 

  41. Shehata N, Burrows R, Kelton JG (1999) Gestational thrombocytopenia. Clin Obstet Gynecol 42:327−334

    Article  PubMed  CAS  Google Scholar 

  42. Kelly R, Arnold L, Richard S et al. (2010) The management of pregnancy in paroxysmal nocturnal haemoglobinuria on long term eculizumab. Br J Haematol 149:146−150

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    D.W. Lüdders, J. Weichert, K. Baumann, F. Hoellen & M.K. Bohlmann

  2. Institut für Klinische Chemie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Deutschland

    D. Manner

  3. Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Großhadern, München, Deutschland

    R. Reibke

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  1. D.W. Lüdders
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  2. D. Manner
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  3. R. Reibke
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  4. J. Weichert
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  5. K. Baumann
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  6. F. Hoellen
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  7. M.K. Bohlmann
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Correspondence to D.W. Lüdders.

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Lüdders, D., Manner, D., Reibke, R. et al. Maternale Thrombozytopenie und Thrombozytopathie. Gynäkologe 44, 527–532 (2011). https://doi.org/10.1007/s00129-010-2736-9

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  • DOI: https://doi.org/10.1007/s00129-010-2736-9

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