A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura

Blood ◽  
2003 ◽  
Vol 102 (13) ◽  
pp. 4306-4311 ◽  
Author(s):  
Kathryn E. Webert ◽  
Richa Mittal ◽  
Christopher Sigouin ◽  
Nancy M. Heddle ◽  
John G. Kelton
Keyword(s):  
Platelet Count ◽  
Retrospective Study ◽  
Epidural Analgesia ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Vaginal Bleeding ◽  
Severe Bleeding ◽  
Thrombocytopenic Purpura ◽  
Platelet Counts ◽  
Itp In Pregnancy ◽  
In Pregnancy

AbstractNumerous studies have examined the outcomes of infants born to mothers with idiopathic thrombocytopenic purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 × 109/L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 × 109/L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 × 109/L; 25.2% of infants had platelet counts lower than 150 × 109/L, and 9% had platelet counts lower than 50 × 109/L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts. (Blood. 2003;102:4306-4311)

A Case of Acquired Amegakaryocytic Thrombocytopenia with Anti-c-mpl Autoantibody: Comparison with Idiopathic Thrombocytopenic Purpura

2019 ◽  
Vol 142 (4) ◽  
pp. 239-243
Author(s):  
Bora Son ◽  
Hee sue Park ◽  
Hye Sook Han ◽  
Hee Kyung Kim ◽  
Seung Woo Baek ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Rare Disease ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Immunosuppressive Treatment ◽  
Severe Bleeding ◽  
Severe Thrombocytopenia ◽  
Thrombocytopenic Purpura ◽  
Acquired Amegakaryocytic Thrombocytopenia

Acquired amegakaryocytic thrombocytopenia (AAMT) is a rare disease that causes severe bleeding. The pathogenesis and treatment of AAMT have not yet been defined. We report the case of a 60-year-old woman diagnosed with AAMT, who presented with severe thrombocytopenia, gastroin­testinal bleeding, and significantly reduced bone marrow megakaryocytes. The patient was treated with methylprednisolone, cyclosporin, and intravenous immunoglobulin. After 2 weeks of treatment, her platelet count started to increase, and her bone marrow megakaryocyte count had normalized 3 months after diagnosis. At the time of diagnosis, the patient was seropositive for anti-c-mpl antibody but was seen to be seronegative once the platelet count recovered. In contrast, anti-c-mpl antibodies were not detected in the serum of 3 patients with idiopathic thrombocytopenic purpura. This case study suggests that anti-c-mpl antibody plays an important role in the development of AAMT, and that intensive immunosuppressive treatment is required for autoantibody clearance and recovery of megakaryocyte count.

Multiple Cycles of Recombinant Human Thrombopoietin Therapy in a Patient with Chronic Refractory Idiopathic Thrombocytopenic Purpura.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3933-3933
Author(s):  
Yongqiang Zhao ◽  
Baolai Hua ◽  
Nong Zou ◽  
Shujie Wang ◽  
Tienan Zhu
Keyword(s):  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Immunosuppressive Agents ◽  
Plasma Concentrations ◽  
Thrombocytopenic Purpura ◽  
Platelet Production ◽  
Platelet Counts ◽  
Multiple Cycles ◽  
Recombinant Human Thrombopoietin ◽  
Refractory Itp

Abstract Thrombopoietin (TPO) is the key regulator of megakaryocytepoiesis and platelet production. TPO binds to its specific receptor, c-Mpl, on the surfaces of megakaryocytes, and may promote the proliferation, differentiation and maturation of megakaryocytes, and finally increase the circulating platelet count. The role of TPO in the pathogenesis of idiopathic thrombocytopenic purpura (ITP) is not certain. Plasma concentrations of TPO in ITP patients were similar to or little lower than that in healthy subjects. Therefore it is possible that supplemental TPO could significantly promote platelet production and increase platelet counts in ITP patients. Here, we report the result of multiple cycles of recombinant human thrombopoietin (rhTPO) therapy in a patient with refractory ITP. The patient, a 42-year-old woman, was admitted to our department on December 30, 2003. She had suffered from chronic ITP for more than 4 years. The patient had been treated with glucocorticosteroids, immunosuppressive agents and splenectomy. No sustained response could be achieved. The diagnosis of chronic refractory ITP was made. There were petechiae and gingival bleeding on admission. Liver and spleen were not palpable. Hemoglobin was 142g/L, white blood cell count 7.6×10 9/L, platelet count 15×10 9/L. Bone marrow aspiration revealed that erythroid and myeloid development were normal, megakaryocytes were increased in number and no dysplastic features. After an informed consent was obtained from the patient, rhTPO (Sunshine Pharmaceutical Corporation, China) was administrated subcutaneously at dosage of 1.0 μg/kg, daily for 14 days or until platelet count sustained more than 50×109/L. Anti-rhTPO antibodies were determined weekly by ELISA. Three cycles of rhTPO therapy was given with 6, 13 and 8 dosing for each cycle. The platelet counts before each cycle were all less than10×109/L and increased above 50×109/L on day 5, 11 and 8 of rhTPO administration, respectively. The peak platelet counts of 456, 130 and 82×109/L were reached on day 9, 15 and 13 for each cycle. Then platelet count decreased gradually. The durations of platelet count more than 50×109/L in 3 cycles were 13, 7 and 10 days respectively. No increase of WBC count and Hb level occurred. No liver and kidney function damage, abnormal coagulation functions or thrombosis developed during the treatment. rhTPO antibodies were not detectable. The result indicated that rhTPO could transiently increase peripheral platelet counts of the patient with chronic refractory ITP. It was uncertain why peak platelet counts declined and durations of platelet count more than 50×109/L shortened when multiple cycles of rhTPO were given.

scholarly journals Immune Thrombocytopenic Purpura in Pregnancy- A Prospective Observational Study in a Tertiary Care Centre

2019 ◽  
Vol 34 (1) ◽  
pp. 15-21
Author(s):  
Tabassum Parveen ◽  
Firoza Begum ◽  
Nahreen Akhter ◽  
Nigar Sultana ◽  
Khairun Nahar
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Observational Study ◽  
Immune Thrombocytopenic Purpura ◽  
Platelet Transfusion ◽  
Prospective Observational Study ◽  
Thrombocytopenic Purpura ◽  
Neonatal Thrombocytopenia ◽  
Itp In Pregnancy ◽  
In Pregnancy

Objectives: Immune thrombocytopenic purpura (ITP) in pregnancy necessitates management of two patients, the mother and the newborn. Complications like maternal bleeding, fetal and neonatal thrombocytopenia demands appropriate and timely therapy. This prospective observational study was designed to explore and summarize the current approach to the investigation, diagnosis, management and outcome of ITP in pregnancy. Materials and Methods: Women with ITP admitted in the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2009 -2017, were included in the study. Total number of high risk pregnancy during that period were 7704 among them 20 cases were pregnancy with Immune Thrombocytopenic Purpura (ITP). Patients were managed under joint supervision of the fetomaternal medicine specialist and the hematologist. Prednisolone was considered as a first line drug in management protocol. Platelet transfusion was considered if there were symptoms or count <20X109/L at any stage of pregnancy or <50 X109 / L in late pregnancy without symptoms. Platelet count of newborn was performed at birth and repeated on day four and count<150X109/L was considered as neonatal thrombocytopenia. Results: Frequency of ITP among high risk patients was found 2.5/1000 live birth, most were preexisting (75%). Almost all cases (95%) were treated with prednisolone. Commonest clinical presentations were gum bleeding (70 %) and purpuric rashes (60%). Though during pregnancy, severe thrombocytopenia (<50 X109/L) was found in 7 patients (35%) but none was at the time of delivery, as drugs and/or platelet transfusion was considered to make delivery process safe. Platelet transfusion needed in 77.7% cases in a range of 1-75 units. Primary PPH noted in 3 cases (17%), increased bleeding during surgery in 5 patients (33%) and one patient needed ICU support. Neonatal thrombocytopenia noted in 5 cases (28%). Though 2 of the neonates needed NICU admission but none needed platelet transfusion and all the babies were discharged healthy. Conclusion: This study documents that pregnancy with ITP need close monitoring, require agents to raise the platelet count and repeated platelet transfusion to maintain reasonable safe platelet count. There are chances of PPH, capillary oozing during surgery. However good outcome is possible for most women, fetus and neonates with appropriate and timely therapy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 15-21

scholarly journals PLATELET COUNT RESPONSE TO HELICOBACTER PYLORI ERADICATION IN IRANIAN ‎PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC ‎PURPURA

2012 ◽  
Vol 4 (1) ◽  
pp. e2012056 ◽  
Author(s):  
Mohammad Erfan Zare
Keyword(s):  
Helicobacter Pylori ◽  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Eradication Therapy ◽  
Complete Response ◽  
Thrombocytopenic Purpura ◽  
Platelet Counts ◽  
Count Response ◽  
Significant Difference ◽  
H Pylori

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune hematological disordercharacterized by auto antibody-mediated platelet destruction. Although the main cause of ITPremains unclear, but its relationship with some infection was demonstrated. In recent years, many studies have demonstrated improvement of platelet counts in ITP patients after treating Helicobacter pylori infection. The aim of this study was to investigate the effects of H. pylori eradication on platelet count response in Iranian ITP patients.A total of 26 patients diagnosed with both ITP and H. pylori infection. ITP were diagnosed whose platelet counts were less than 100×103/μL. These patients were tested for H. pylori infection by Urea Breath Test and serum H. pylori antibody. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection. These patients followed for six months.Prevalence of H. pylori was 67.3%. H. pylori eradication achieved in 89.5% (26/29). Of the 26 patients, 15 (57.7%) exhibited a complete response (CR) and 11 (42.3%) were unresponsive. We did not find partial responders. There was a significant difference in the baseline platelet count of responders and non-responders patients (p<0.001). All responders had platelet count ≥50×103/μLand all non-responders had platelet count <50×103/μL.Results of this study revealed that eradication therapy of H. pylori infection can improve platelet counts in ITP patients especially with mild thrombocytopenia and support routine detection andtreatment of H. pylori infection in ITP patients in populations with a high prevalence of this infection.

Platelet Survival Studies in Aldrich Syndrome

PEDIATRICS ◽  
1966 ◽  
Vol 37 (2) ◽  
pp. 339-341
Author(s):  
WILLIAM KRVIT ◽  
EDMUND YUNIS ◽  
JAMES G. WHITE
Keyword(s):  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Plasma Transfusion ◽  
Thrombocytopenic Purpura ◽  
Platelet Counts ◽  
Platelet Antibodies ◽  
Normal Plasma ◽  
Platelet Survival ◽  
Significant Length ◽  
Survival Studies

1. Normal platelets were transfused into 4 patients with Aldrich syndrome. The response in platelet count indicated that little destruction of platelets was occurring. The survival of platelets was considered to be normal. Plasma transfusion alone did not correct the platelet counts. Platelet antibodies were not detected in two of these patients. 2. For control studies, normal platelets were transfused into two patients with amegakaryocytotic congenital thrombocytopenia and sex-linked recessive (non-Aldrich) familial thrombocytopenia. Their survival was normal. Similarly, normal platelets were transfused into three patients with idiopathic thrombocytopenic purpura. Minimal increase in platelets and no significant length of survival of platelets was seen. The thrombocytopenia of Aldrich syndrome was considered to be due to a defect in procduction and/or release of platelets.

scholarly journals Idiopathic Thrombocytopenic Purpura & Total Knee Arthroplasty: How Low Can You Go

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Harkeerat Singh ◽  
Kunalan Ganthel
Keyword(s):  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Surgical Procedures ◽  
Autoimmune Disorder ◽  
Immunoglobulin Therapy ◽  
Immune Disorder ◽  
Thrombocytopenic Purpura ◽  
Platelet Counts ◽  
History Of ◽  
Total Knee

Idiopathic thrombocytopenic purpura or ITP is  an autoimmune disorder with a reduction in circulating platelets, it subjects patients to spontaneous torrential bleeding even with trivial trauma. In this case report we share our experience conducting a TKR in a patient with refractory ITP. A 64-year-old patient with ITP complicated with history of ICB in 2001 presented with bilateral knee pain. Her platelet counts were 60x109 /L despite previous steroidal and immunoglobulin therapy. After discussion haematologist a manual platelet count under microscopy had 15-20/hpf large platelets with estimated counts to be 100x109 /L. She underwent a cemented right TKR under general anaesthesia. No femoral/sciatic block was performed nor was a tourniquet applied fearing an intramuscular haematoma/ecchymosis. Two grams of intravenous tranexemic acid was given prior to the surgery and four units of platelets were transfused intraoperatively. Despite no tourniquet, she clotted very well and blood loss was minimal. Thereafter, ITP is an immune disorder where patients form antibodies towards their own platelets resulting in increased platelet destruction and a decrease in platelet formation. Remaining circulating platelets are bigger than usual platelets, however, their function are not impaired. ITP guidelines by the British Journal Of Haematology dictate a minimal platelet count of 50x109 /L for minor surgical procedures and 80x109 /L for major surgical procedures. It is still safe to perform TKR in ITP patients. However a combined approach with haematology is advocated as manual platelet counts give a better representation of the actual number of circulating platelets compared to routine blood counts.

scholarly journals Rituximab – A novel therapy for severe ITP in pregnancy: A case report

2018 ◽  
Vol 12 (4) ◽  
pp. 196-198 ◽  
Author(s):  
Fionan Donohoe ◽  
Mary Higgins ◽  
Shane Higgins ◽  
Fionnuala McAuliffe ◽  
Karen Murphy
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenic Purpura ◽  
Case Reports ◽  
Limited Information ◽  
Novel Therapy ◽  
Thrombocytopenic Purpura ◽  
Minimal Data ◽  
Itp In Pregnancy ◽  
Safe Treatment Option ◽  
In Pregnancy

Background Rituximab is a novel second-line agent for the treatment of immune thrombocytopenic purpura. Minimal data exist on the use of rituximab in pregnancy. This case illustrates the successful treatment of severe immune thrombocytopenic purpura diagnosed in pregnancy, refractory to all other medical management. Case A 32-year-old nulliparous woman was diagnosed with severe immune thrombocytopenic purpura at the time of booking for antenatal care (platelet level of 13 × 109/L). Standard treatment failed to adequately increase her platelet count. Therapy with rituximab was instituted, and her platelet count rose to normal levels, without side effects, and remained at a normal level throughout the pregnancy. There were no maternal or neonatal ill-effects of rituximab therapy. Conclusion Rituximab is potentially a safe treatment option for the management of immune thrombocytopenic purpura in pregnancy with good maternal and neonatal outcome when conventional treatments have been unsuccessful. Research is limited to case reports, and therefore limited information currently exists to guide clinicians.

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