Hamostaseologie 2025; 45(S 01): S90
DOI: 10.1055/s-0044-1801684
Abstracts
Topics
T-10 Platelets – Disorders of platelet function and numbers

Managing immune thrombocytopenia (ITP) during pregnancy- Single centre 15 years experience at a tertiary care institute

Authors

  • S Chopra

    1   Post Graduate Institute of Medical Education & Research, Department of Obstetrics and Gynecology, Chandigarh, India

  • P Sikka

    1   Post Graduate Institute of Medical Education & Research, Department of Obstetrics and Gynecology, Chandigarh, India

  • A Jain

    2   Post Graduate Institute of Medical Education & Research, Department of Hematology, Chandigarh, India

  • A Kaur

    1   Post Graduate Institute of Medical Education & Research, Department of Obstetrics and Gynecology, Chandigarh, India
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Introduction: Immune thrombocytopenia (ITP) is associated with alterations in the immune system at the maternal–fetal interface which promote tolerance of shared fetal–paternal alloantigens through a shift toward the predominance of type 2 helper T cells. IgG antiplatelet antibodies accelerate platelet clearance and reduce platelet production. An impairment in platelet production has been suggested on the basis of the elevated estradiol and serum thrombopoietin levels in pregnant women with ITP , may be from placental source. ITP Prevalence is more than 1 million cases globally, commonly in women of childbearing age. Even during uncomplicated pregnancies with ITP, platelet counts may fall, platelet clearance may be accelerated, surgical delivery may be required, and IgG antiplatelet antibodies can also be transported across the placenta to the fetus. These factors complicate the diagnosis and management of ITP in pregnancy and require a multidisciplinary approach.

Method: We collected data of 95 pregnancies over last 15 years retrospectively who were managed in special antenatal clinic of medical-surgical disorders Post Graduate Institute of Medical Education & Research, Chandigarh. Autoimmune work up was done in all patients.Platelet count was done at regular intervals of 3-4 weeks, dose of steroids was altered accordingly. Steroids were the mainstay of treatment after diagnosis, tapered to maintenance dose in pregnacy. Autoimmune work up was done in all patients. Platelet transfusion(random donor platelets/ SDAP-single donor apheresis) was done in symptomatic patients, those requiring intervention/delivery or surgical procedure, count<10000 and to maintain a count of>20000 during pregnancyin asymptomatic women IVIG and Pulse Methyl prednisolone was given as per consultation with haematologist [1] [2] [3] [4] [5] [6].

Results: Age group was 25.3±4.8 years, 90.2% were multiparous.<6.3% diagnosed during index pregnancy.93% were diagnosed prenatally-36.8% due to wet purpura, 15.7% for dry purpura with significant thrombocytopenia<15 k. Bone marrow aspirate was diagnostic in 34.7%. 47.3% were on maintainance steroids in pregnancy. Dapsone(6) and Danazol(7) were also given in prenatal period only. 6/95 received steroid pulse therapy and 9/95 received IVIG for low counts. Splenectomy was done for chronic ITP with splenomegaly in 16.95%, all before pregnancy and they did not require any further treatment in pregnancy. Labour was managed under SDAP cover, 65.2% delivered vaginally, 33.6% caesarean for obstetric indications. Neonatal outcome was 90% term , 2.6-3.1 kg birth weightneonates. No maternal or neonatal complications due to thrombocytopenia were observed.

Conclusion: ITP is not a contraindication for pregnancy. Monitoring platelet count and appropriate intervention with drugs, supportive transfusions help achieve optimal maternal and neonatal outcomes.Maintainig an adequate platelet count with supportive tansfusions helps preventing complications and achieve optimal feto-maternal outcome



Publication History

Article published online:
13 February 2025

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