Article ; Online: Thrombocytopenia in pregnancy.
Hematology. American Society of Hematology. Education Program
2017 Volume 2017, Issue 1, Page(s) 144–151
Abstract: Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a ... ...
| Abstract | Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances made over the past 5 to 10 years in understanding and managing the more common causes of thrombocytopenia in pregnancy. Recent trends in the management of immune thrombocytopenia translate into more women contemplating pregnancy while on treatment with thrombopoietin receptor agonists, rituximab, or mycophenylate, which pose known or unknown risks to the fetus. New criteria to diagnose preeclampsia, judicious reliance on measurement of ADAMTS13 to make management decisions in suspected thrombotic thrombocytopenic purpura, new evidence supporting the efficacy and safety of anticomplement therapy for atypical hemolytic uremic syndrome during pregnancy, and implications of thrombotic microangiopathies for subsequent pregnancies are evolving rapidly. The goals of the chapter are to help the hematology consultant work through the differential diagnosis of thrombocytopenia in pregnancy based on trimester of presentation, severity of thrombocytopenia, and coincident clinical and laboratory manifestations, and to provide guidance for dealing with some of the more common and difficult diagnostic and management decisions. |
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| MeSH term(s) | ADAMTS13 Protein/deficiency ; Female ; Humans ; Mycophenolic Acid/adverse effects ; Mycophenolic Acid/therapeutic use ; Postpartum Period ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/drug therapy ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis ; Pregnancy Complications, Hematologic/drug therapy ; Purpura, Thrombotic Thrombocytopenic/diagnosis ; Purpura, Thrombotic Thrombocytopenic/drug therapy ; Receptors, Thrombopoietin/agonists ; Rituximab/adverse effects ; Rituximab/therapeutic use |
| Chemical Substances | Receptors, Thrombopoietin ; MPL protein, human (143641-95-6) ; Rituximab (4F4X42SYQ6) ; ADAMTS13 Protein (EC 3.4.24.87) ; ADAMTS13 protein, human (EC 3.4.24.87) ; Mycophenolic Acid (HU9DX48N0T) |
| Language | English |
| Publishing date | 2017-11-21 |
| Publishing country | United States |
| Document type | Journal Article ; Review |
| ISSN | 1520-4383 |
| ISSN (online) | 1520-4383 |
| DOI | 10.1182/asheducation-2017.1.144 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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