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 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.

Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura

Blood ◽  
2010 ◽  
Vol 115 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Donald M. Arnold ◽  
Ishac Nazi ◽  
Aurelio Santos ◽  
Howard Chan ◽  
Nancy M. Heddle ◽  
...  
Keyword(s):  
Platelet Count ◽  
Mycophenolate Mofetil ◽  
Adverse Events ◽  
Observational Study ◽  
Immune Thrombocytopenic Purpura ◽  
Treatment Options ◽  
Initial Response ◽  
Immunosuppressant Therapy ◽  
Thrombocytopenic Purpura ◽  
Refractory Itp

Abstract Treatment options for patients with chronic refractory immune thrombocytopenic purpura (ITP) are limited. Because combination immunosuppressant therapy appeared to be effective in ITP and other disorders, we used this approach in patients with particularly severe and refractory ITP. In this retrospective, observational study, we determined the response (platelet count above 30 × 109/L and doubling of baseline) among 19 refractory ITP patients. Treatment consisted of azathioprine, mycophenolate mofetil, and cyclosporine. The patients had failed a median of 6 prior treatments, including splenectomy (in all except 1). Of 19 patients, 14 (73.7%) achieved a response lasting a median of 24 months, after which time 8 (57.1%) relapsed. Of the 8 relapsing patients, 6 responded to additional treatments. Of the 14 patients who achieved an initial response, 2 (14.3%) remained in remission after eventually stopping all medications. Severe adverse events did not occur. Combination immunosuppressant therapy can produce a rise in the platelet count that is sometimes sustained in refractory ITP patients.

Linear decline of corrected platelet count increment within 24 hours after platelet transfusion in haematological patients: A prospective observational study

2017 ◽  
Vol 99 (6) ◽  
pp. 559-568 ◽  
Author(s):  
Sigurdur Benediktsson ◽  
Vladimir Lazarevic ◽  
Lars Nilsson ◽  
Jens Kjeldsen-Kragh ◽  
Ulf Schött ◽  
...  
Keyword(s):  
Platelet Count ◽  
Observational Study ◽  
Platelet Transfusion ◽  
Prospective Observational Study ◽  
Haematological Patients ◽  
Linear Decline

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)

W257 NEW-ONSET IMMUNE THROMBOCYTOPENIC PURPURA (ITP) IN PREGNANCY

2012 ◽  
Vol 119 ◽  
pp. S788-S789
Author(s):  
J. Wahba ◽  
R. Jaspal ◽  
V. Tailor ◽  
N. Garg ◽  
K. Joash
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Thrombocytopenic Purpura ◽  
Itp In Pregnancy ◽  
In Pregnancy ◽  
New Onset

scholarly journals A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

2021 ◽  
Vol 10 (4) ◽  
pp. 1637
Author(s):  
Khushboo Goel ◽  
Sanjaykumar G. Tambe
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Observational Study ◽  
Maternal Mortality ◽  
Prospective Observational Study ◽  
Neonatal Outcome ◽  
Risk Group ◽  
High Risk Group ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Background: Prevalence of heart disease in pregnancy vary from 0.3-3.5%. Normal pregnancy is associated with physiological cardiovascular changes. These changes may unmask underlying cardiac disease in normal women and increase morbidity and mortality in women with heart disease. Heart disease in pregnancy is an important cause of maternal mortality in India. The aim of this study was to evaluate the maternal and neonatal outcome of pregnancy with heart disease.Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India. 75 patients who fulfilled the inclusion criteria were studied. Maternal and neonatal outcome were analyzed.Results: Maternal heart disease was classified into congenital (36%) and acquired (64%). In acquired variety, rheumatic heart disease was most commonly seen. In congenital, ASD was most common. We divided the cases into two groups based on their NYHA status, low risk group had 74.67% patients and high risk group had 25.33% patients. The most common antenatal complication was PROM (41.3%). There was statistically significant association between ICU admission and high-risk group. The most common neonatal complications were IUGR and prematurity. Maternal mortality rate in the study group was 6.6%.Conclusions: The perinatal outcome of heart disease in pregnancy is more dependent on the severity of symptoms rather than the duration and type of heart disease. Multidisciplinary evaluation is necessary. Suboptimal optimization of the heart condition in the antenatal period and delayed referral were the major risk factor for maternal mortality. 

scholarly journals Safety and Efficacy of Thrombopoietin Analogs in the Treatment of Chronic Thrombocytopenic Purpura in Children: A Systematic Review

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4215-4215
Author(s):  
Usman Ali Akbar ◽  
Vivek Soorya Sathya Moorthy ◽  
Sudeep Yadav ◽  
Saman Bahram ◽  
Adnan Mehboob Qureshi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Platelet Count ◽  
Placebo Group ◽  
Observational Study ◽  
Immune Thrombocytopenic Purpura ◽  
Research Funding ◽  
Pediatric Population ◽  
Platelet Response ◽  
Thrombocytopenic Purpura ◽  
Double Blinded

Abstract Introduction Immune thrombocytopenic purpura (ITP) is an autoimmune disorder consisting of low platelet count, purpura, and hemorrhagic episodes, caused by antiplatelet autoantibodies. Children who develop chronic or refractory ITP are at risk of bleeding after failing first-line therapies. Thrombopoietin analogs -Eltrombopag and romiplostim are safe and effective treatment options. Thrombopoietin receptor agonists (TPO-Ras) improve platelet production by activating the thrombopoietin pathway. They also stimulate megakaryocytes and hematopoietic stem cells. We analyzed the efficacy and toxicity of romiplostim and eltrombopag in chronic immune thrombocytopenic purpura in the pediatric population (1-17 years). Materials/Methods Following the PRISMA guidelines, we performed a comprehensive literature search on Pubmed, Embase, Cochrane Library, Web of Science, and Clinicaltrials.gov. We used the following keywords, "Thrombopoitein analogs", "TPOs", "Immune thrombocytopenic purpura", "Eltrombopag" and "Romiplostim" MeSh terms from the inception of data till 06/17/2021. We screened initial results from the search of 358 articles focusing on the pediatric population and finally included 9 clinical trials and 1 observational study. We excluded all case reports, case series, preclinical trials, review articles, and meta-analyses. We extracted the data for efficacy (platelet response, baseline platelet count, and Platelet count at first response) and safety (Bleeding or Grade ≥ 3 Adverse Events). Results: Romiplostim A total of 185 patients were analyzed in five clinical trials and 1 observational study employing Romiplostim in the treatment group. Platelet response (PR) (platelet count &gt;50 × 109/L) has been reported in all the studies. In 3 randomized double-blinded control trials by Bussel 2011, Elfaly 2011, and Tarantino 2016, Romiplostim achieved a platelet response of 81.69% vs 12.9% in the placebo group. The other three studies reported substantial platelet response as stated in table 1. In all the studies 25 participants had a prior splenectomy. The most common side effects reported in the studies were bleeding (56.75%), headache (58.64%), contusion (50.76%), and epistaxis (49.23%). Clinically significant bleeding (grade 2-4) was reported by 2 studies in Romiplostim vs placebo group (71.08% vs 96%). Eltrombopag A total of 246 patients were analyzed in five clinical trials and 1 observational study. In a randomized double-blinded multicenter study by Grainger et al., Eltrombopag achieved a PR of 39.68% vs 3.4% in the placebo group. Other clinical trials reported a PR of 55.85% whereas the observational study by Neuner et al. reported a PR of 72% in the patient population. Clinically significant bleeding was reported by Grainger et al. and was 47 % in the eltrombopag group vs 7% in the placebo group. Fifteen patients in all the studies had a prior splenectomy. Conclusion: Thrombopoietin analogs such as romiplostim and eltrombopag show substantial platelet response and are associated with minimal side effects. However, more randomized clinical trials are needed to compare their head-to-head efficacy and safety in the treatment of chronic immune thrombocytopenic purpura in pediatric patients. Figure 1 Figure 1. Disclosures Anwer: Janssen pharmaceutical: Honoraria, Research Funding; GlaxoSmithKline: Research Funding; Allogene Therapeutics: Research Funding; BMS / Celgene: Honoraria, Research Funding.

scholarly journals Increased Frequency of Immune Thrombocytopenic Purpura in Coeliac Disease and Vice Versa: A Prospective Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Stefano Bibbò ◽  
Claudio Fozza ◽  
Giovanni Mario Pes ◽  
Rodrigo Rojas ◽  
Roberto Manetti ◽  
...  
Keyword(s):  
General Population ◽  
Observational Study ◽  
Coeliac Disease ◽  
Immune Thrombocytopenic Purpura ◽  
Prospective Observational Study ◽  
Immune Disorders ◽  
Odds Ratios ◽  
Thrombocytopenic Purpura ◽  
Previous Diagnosis ◽  
Increased Risk

Introduction. Coeliac disease (CD) and immune thrombocytopenic purpura (ITP) are immune conditions, often associated with other immune disorders. In recent years, increasing attention has been directed towards the association between ITP and CD. Aim. To investigate the frequency of ITP in CD patients and vice versa and to assess the risk of their association. Patients and Methods. This was a prospective observational study. All consecutive patients with CD or ITP attending our department were enrolled between January 2016 and December 2017. All patients with CD were screened for ITP and patients with ITP for CD. Odds ratios (ORs) were calculated based on the prevalence in the general population. Results. Two hundred sixty-one CD patients (212 female, mean age 47 ± 16.1 years) and 32 ITP patients (17 female, mean age 57.8 ± 17.4 years) were enrolled. In the CD cohort, two patients (2/261; 0.8%) reported a previous diagnosis of ITP, compared to the general population; OR was 15.3 (95% CI, 3.82–61.73; p<0.0001). Similarly, in the ITP cohort, two patients (2/32; 6.3%) had a previous diagnosis of CD (OR: 9.89, 95% CI, 2.27–43.16; p=0.0002). Discussion. A greater frequency of ITP in coeliac patients and vice versa was observed in our study, suggesting an increased risk for patients of developing both disorders.

New-onset immune thrombocytopenic purpura (ITP) in pregnancy

2012 ◽  
Vol 97 (Suppl 1) ◽  
pp. A68.4-A69
Author(s):  
J Wahba ◽  
R Jaspal ◽  
V Tailor ◽  
N Garg ◽  
K Joash
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Thrombocytopenic Purpura ◽  
Itp In Pregnancy ◽  
In Pregnancy ◽  
New Onset

scholarly journals A Multicenter Open-Labeled Pilot Study on Recombinant Human Thrombopoietin in the Management of Immune Thrombocytopenia in Pregnancy

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 865-865 ◽  
Author(s):  
Zhangyuan Kong ◽  
Ping Qin ◽  
Hong Li ◽  
Renchi Yang ◽  
Xiaofan Liu ◽  
...  
Keyword(s):  
Platelet Count ◽  
Birth Weight ◽  
Adverse Events ◽  
Gestational Age ◽  
Immune Thrombocytopenia ◽  
Platelet Transfusion ◽  
Platelet Counts ◽  
Itp In Pregnancy ◽  
Recombinant Human Thrombopoietin ◽  
In Pregnancy

Abstract Immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by transient or persistent decrease of platelet count. ITP is the most common cause of thrombocytopenia in early pregnancy. Patients with severe thrombocytopenia (platelet count < 20 ×109/L) are at risk of spontaneous bleeding, postpartum hemorrhage and placental abruption. The aim of this study is to determine the efficacy and the safety of recombinant human thrombopoietin (rhTPO) in the management of ITP in pregnancy. This study is registered at www.clinicaltrials.gov as NCT02391272. Patients at eight centers in China were enrolled. Enrollment criteria were pregnant women aged between 18 and 50, who failed to respond to first-line treatments of ITP and/or were refractory to platelet transfusion. Patients' platelet counts were below 30×109/L with bleeding manifestations. Gestational age of the patients was over 12 weeks. Informed consent was obtained from each patient in accordance with the Declaration of Helsinki. Thirty-one patients were enrolled into the study. The median age of the pregnant ITP patients was 26 years (range 19 - 39 years) and 90.6% (29/31) were primigravidae. The median gestational age was 24 weeks (12 - 38 weeks). The median baseline platelet count was 10×109/L (range 1 - 29×109/L). 74.2% (23/31) of these patients were diagnosed as ITP before pregnancy and 25.8 % (8/31) during pregnancy. All eligible participants received rhTPO at an initial dose of 300U/kg once daily subcutaneously for 14 days, 74.2% (23/31) of these patients responded to the initial 14-day rhTPO therapy, including 10 CR and 13 R. Eight patients were NR though their platelet counts rose mildly. The median platelet count of responder was 100×109/L (range from 30 to 250×109/L) at day 14. Then the responders received sequential maintenance therapy through the end of week 12 after delivery. To reduce the risk of thrombocytosis during maintenance, dose was tapered to 300U/kg every other day when platelet counts exceeded 50 ×109/L and treatment stopped when platelet counts above 100×109/L. Only one responder had a transient loss of response due to influenza. After dose adjustment of rhTPO from 300U/kg every other day to 300U/kg every day, the platelet count exceeded 50×109/L in the next visit. The platelet counts gradually dropped after withdrawal of rhTPO. The relapse free survival (platelet count at least 30×109/L) at week 4 and week 12 after withdrawal of rhTPO was 69.6%(16/23) and 21.7%(5/23), respectively (Figure 1). Safety and adverse events were evaluated in all 31 participants. rhTPO was well tolerated. Only mild previously reported adverse events were observed, including one case of dizziness, one of fatigue and one of pain at injection site. There were no new reported adverse events during the observation period and no adverse event-related study withdrawals. In all the 31 newborns, the median age of gestation was 39 weeks (range 36-40, 3 cases had age of gestation< 37 weeks); median birth weight was 3.1 kg (range 2.3-4.2kg, 2 had birth weight<2.5 kg) and the median platelet count at birth was 132×109/L (range 53-263 ×109/L, 9 with platelet<100×109/L) (Table 1). The incidence of premature labor, birth weight and platelet count were similar to previous study on pregnancy outcome in patients with ITP. None of the neonates had bleeding at birth. All 31 infants were evaluated for safety. No adverse effect on the development of newborns was observed during 6 months follow-up. One case of abdominal distension had been reported, which was supposed not associated with rhTPO. This study demonstrates that rhTPO is a potentially effective, safe and fast-onset treatment for ITP in pregnancy refractory to fist-line therapy and platelet transfusion. Our study paved the way for the clinical application of rhTPO and other thrombopoietic agents in the management of ITP in pregnancy. Disclosures No relevant conflicts of interest to declare.

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