Occurence, etiology and clinical significanceof trombocytopenia in pregnancy

Czech version

Authors: P. Brychtová ¹; M. Procházka ^2,5; V. Lattová ²; M. Lubušký ²; J. Procházková ³; L. Slavík ³; J. Úlehlová ³; O. Šimetka ⁴
Authors‘ workplace: Porodnicko-gynekologické oddělení, Krajská nemocnice T. Bati, a. s., Zlín, přednosta MUDr . Z. Adamík, Ph. D. ¹; Porodnicko-gynekologická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ²; Hematologicko-onkologická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. K. Indrák, DrSc. ³; Porodnicko-gynekologická klinika FN, Ostrava, přednosta doc. MUDr. V. Unzeitig, CSc. ⁴; Ústav porodní asistence FZV UP, Olomouc, přednostka Mgr. V. Vránová, Ph. D. ⁵
Published in: Ceska Gynekol 2013; 78(6): 560-565
Category: Original Article

Overview

Objective:
The principal objective of the study is to compare results from the experimental group of pregnant women suffering from thrombocytopenia in pregnancy with results from the control group of pregnant women with normal physiologic blood platelet count.

Setting:
Department of Obstetrics and Gynaecology of the Tomas Bata Regional Hospital Zlín, Obstetrics and Gynaecology Clinic, Haematology and Oncology Clinic of the Palacky University Teaching Hospital and Medical School in Olomouc, Obstetrics and Gynaecology Clinic of the Ostrava Teaching Hospital.

Methodology:
A group of 200 pregnant women suffering from thrombocytopenia underwent thorough medical tests. The level of platelets, presence of anti-platelets agents, liver function (LFT), anti-phospholipid antibodies, complete blood count with differential, specific antibodies for hepatitis B and C, Lyme borreliosis and cytomegalovirus were determined from venous blood using the EIA, ELISA methods.

Results:
Medical articles and books about thrombocytopenia divide the causes for thrombocytopenia as follows: 79.5% benign gestational thrombocytopenia, 16% preeclampsia, 2.5% HELLP syndrome, 1% immune thrombocytopenia, 1% HVC. The number of women who developed physiological anaemia in pregnancy and were overweight is identical in the experimental group of pregnant women suffering from thrombocytopenia and in the control group of pregnant women with normal physiologic blood platelet count, and the proportion of the different age groups in the two groups of pregnant women is also identical.

Conclusion:
32% of pregnancies in the experimental group ended in a caesarean section, of which 13.5% in a group of 127 pregnant women suffering from mild thrombocytopenia, 17.5% in a group of 71 pregnant women suffering from moderate thrombocytopenia and 1% in a group of 2 pregnant women suffering from severe thrombocytopenia. 20.5% pregnancies in the control group ended in caesarean section.

Keywords:
thrombocytopenia – pregnancy – management of labour

Sources

1. Aster, RH., Curtis, BR., McFarland, JG., et al. Drug-induced immune trombocytopenia, s. pathogenesis, diagnosis and management. J Thromb Haemost, 2009, 7, p. 911–918.

2. Cines, DB, .Liebman, HA. The immune trombocytopenia syndrome, s. a disorder of diverse pathogenesis and clinical presentation. Hematol Oncol Clin North Am, 2009, 23, p. 1155–1161.

3. Červinek, L. Imunitní trombocytopenie, diagnostika, klasifikace, diferenciální diagnostika. Vnitř Lék, 2010, 56, s. 75–77.

4. Crowther, MA., George, JN. Thrombotic trombocytopenic purpura. Clin J Med, 2008, 75, p. 369–375.

5. Fakhouri, F., Roumenina, L., Provot, F., et al. Pregnancy – associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol, 2010, 21, p. 859

6. George, JN., Aster, RH. Drug - induced trombocytopenia: pathogenesis, evaluation, and management. Hematology Am Soc Hematol Educ Program, 2009, p. 153–158.

7. Karumanchi, SA., Lindheimer, MD. Advances in the under-standing of eclampsia. Curr Hypertens Rep, 2008, 10, p. 305–312.

8. Levi, M. Disseminated intravascular coagulation. Crit Care Med, 2007, 35, p. 2191–2195.

9. Lim, W. Antiphospolipid antipody syndrome. Hematology Am Soc Hematol Educ Program, 2009, p. 233–239.

10. McCrae, KR. Thrombocytopenia in pregnancy. ASH Education Book December 4, 2010, vol. 2010, 1, p. 397–402.

11. Myers, B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Hematol, 2012, 158, p. 3.

12. Provan, D., Stasi, R., Newland, AC., et al. International consensus report on the investigation and management of primary immune trombocytopenia. Blood, 2010, 115, p. 168–186.

13. Rath, W., Fischer, T. The diagnosis and treatment of hypertensive disorders in pregnancy, s. new findings for antenatal and inpatient care. Dtsch Artzebl Int, 2009, 106, p. 733–738.

14. Stasi, R. How to approach thrombocytopenia. ASH Education Book December 8, 2012 vol. 2012, 1, p. 191–197.

15. Šimetka, O., Brychtová, P., Procházková, J., Procház-ka, M. Laboratorní změny aktivace endotelu u syndromu HELLP. Gynekolog, 2008, 2, s. 48–53.

16. Šimetka, O., Michalec, I., Zewdiová, H., et al. Průběh a výsledky 34 těhotenství komplikovaných syndromem HELLP. Čes Gynek, 2010, 75(3), s. 242–247.

17. Yong, B., Levine, RJ., Sazahuddin, S., et al. The use of angio-genetic biomarkers to differentiate non-HELLP related tombocytopenia from HELLP syndrom. J Matern Fetal Neonatal Med, 2010, 23, p. 366.,