Immunthrombozytopenie (ITP) und andere Thrombozytopenien in der Schwangerschaft

Zusammenfassung

Thrombozytopenien in der Schwangerschaft sind häufig. Bei isolierter, leichter Thrombozytopenie (100 000 – 150 000/µl) handelt es sich in der Regel um eine harmlose Gestationsthrombozytopenie. Bei Werten unter dieser Schwelle sollte eine Abklärung erfolgen, um Präeklampsie/HELLP-Syndrom, eine Immunthrombozytopenie (ITP) oder einige weitere seltene Ursachen nicht zu übersehen. In dieser Arbeit werden typische Symptome, Differenzialdiagnostik und therapeutisches Vorgehen für die tägliche Praxis dargestellt.

Abstract

Thrombocytopenia in pregnancy is common. Mildly decreased values (100 000 – 150 000/µl) are harmless and most often due to gestational thrombocytopenia. Values below this threshold require further workup because preeclampsia/HELLP syndrome, immune thrombocytopenia (ITP), and some other less common causes must not be missed. If the patient has ITP and needs treatment, corticosteroids or immunoglobulins will be offered. The risk of postpartum haemorrhage is relevant and the newborn may also develop transient thrombocytopenia. The care of the pregnant woman should be closely coordinated between gynaecologist, haematologist and paediatrician, if necessary, the patient must be referred to a centre with adequate experience. This paper outlines clinical presentation, differential diagnosis and therapy with focus on the approach in daily practice.

Kernaussagen

• Thrombozytopenien sind ein häufiges Phänomen in der Schwangerschaft.

• Milde Verlaufsformen bedürfen in der Regel keiner weiteren Diagnostik oder Therapie. Bei unter 100 000 Thrombozyten/µl wird man jedoch die Ursache abklären und gegebenenfalls eine Behandlung initiieren.

• Wichtige Hinweise geben der Zeitpunkt des Auftretens, die Schwere der Thrombozytopenie und Begleitsymptome (Blutdruck, Proteinurie, Leber-, Nierenwerte, Neurologie).

• Die meisten Therapieempfehlungen beruhen auf empirischen Daten und kleinen Fallserien.

• Die Betreuung der Schwangeren sollte zwischen Gynäkologen, Hämatologen und Pädiater eng abgestimmt sein, gegebenenfalls muss die Patientin dazu an ein entsprechend erfahrendes Zentrum verwiesen werden.

Schlüsselwörter Immunthrombozytopenie - Gestationsthrombozytopenie - Schwangerschaft

Key words immune thrombocytopenia - gestational thrombocytopenia - pregnancy

• Literatur

• 1 Reese JA, Peck JD, Deschamps DR. et al. Platelet counts during pregnancy. N Engl J Med 2018; 379: 32-43 doi:10.1056/NEJMoa1802897
• 2 Sainio S, Kekomäki R, Riikonen S. et al. Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 2000; 79: 744-749 doi:10.1034/j.1600-0412.2000.079009744.x
• 3 Pishko AM, Levine LD, Cines DB. Thrombocytopenia in pregnancy: Diagnosis and approach to management. Blood Rev 2020; 40: 100638 doi:10.1016/j.blre.2019.100638
• 4 Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood 2013; 121: 38-47 doi:10.1182/blood-2012-08-448944
• 5 Rajasekhar A, Gernsheimer T, Stasi R. et al. Clinical practice guide on thrombocytopenia in pregnancy. Washington, DC: American Society of Hematology; 2013. Im Internet: www.hematology.org/Clinicians/Guidelines-Quality/Quick-Reference.aspx Stand: 07.04.2020
• 6 Rottenstreich A, Israeli N, Levin G. et al. Clinical characteristics, neonatal risk and recurrence rate of gestational thrombocytopenia with platelet count < 100 × 10⁹/L. Eur J Obstet Gynecol Reprod Biol 2018; 231: 75-79 doi:10.1016/j.ejogrb.2018.10.026
• 7 Zhang X, Zhao Y, Li X. et al. Thrombopoietin: a potential diagnostic indicator of immune thrombocytopenia in pregnancy. Oncotarget 2016; 7: 7489-7496 doi:10.18632/oncotarget.7106
• 8 Neunert C, Terrell DR, Arnold DM. et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 2019; 3: 3829-3866 doi:10.1182/bloodadvances.2019000966
• 9 Provan D, Arnold DM, Bussel JB. et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 2019; 3: 3780-3817 doi:10.1182/bloodadvances.2019000812
• 10 Rodeghiero F, Marranconi E. Management of immune thrombocytopenia in women: current standards and special considerations. Expert Rev Hematol 2020; 13: 175-185 doi:10.1080/17474086.2020.1711729
• 11 Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Hematol 2000; 37: 275-289 doi:10.1016/s0037-1963(00)90106-9
• 12 Sachs UJ. Diagnosing immune thrombocytopenia. Hamostaseologie 2019; 39: 250-258 doi:10.1055/s-0039-1678739
• 13 Hauschner H, Rosenberg N, Seligsohn U. et al. Persistent neonatal thrombocytopenia can be caused by IgA antiplatelet antibodies in breast milk of immune thrombocytopenic mothers. Blood 2015; 126: 661-664 doi:10.1182/blood-2014-12-614446
• 14 Chey WD, Leontiadis GI, Howden CW. et al. ACG clinical guideline: treatment of helicobacter pylori infection. Am J Gastroenterol 2017; 112: 212-239 doi:10.1038/ajg.2016.563
• 15 Loustau V, Debouverie O, Canoui-Poitrine F. et al. Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women. Br J Haematol 2014; 166: 929-935 doi:10.1111/bjh.12976
• 16 British Committee for Standards in Haematology. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120: 574-596 doi:10.1046/j.1365-2141.2003.04131.x
• 17 Bundesärztekammer. Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten. 4. überarbeitete und aktualisierte Auflage 2014. Im Internet: http://www.bundesaerztekammer.de/aerzte/medizin-ethik/wissenschaftlicher-beirat/veroeffentlichungen/haemotherapie-transfusionsmedizin/querschnitt-leitlinie/ Stand: 07.04.2020
• 18 Kong Z, Qin P, Xiao S. et al. A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy. Blood 2017; 130: 1097-1103 doi:10.1182/blood-2017-01-761262
• 19 Burrows RF, Kelton JG. Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynecol 1990; 163 (4 Pt 1): 1147-1150 doi:10.1016/0002-9378(90)90675-w
• 20 AWMF-Register Nr. 086/001, Klasse: S2k, Leitlinie 086-001: Neu diagnostizierte Immunthrombozytopenie im Kindes- und Jugendalter. Im Internet: https://www.awmf.org/leitlinien/detail/ll/086-001.html Stand: 07.04.2020
• 21 Goodier CG, Lu JT, Hebbar L. et al. Neuraxial anesthesia in parturients with thrombocytopenia: a multisite retrospective cohort study. Anesth Analg 2015; 121: 988-991 doi:10.1213/ANE.0000000000000882
• 22 Pourrat O, Coudroy R, Pierre F. Differentiation between severe HELLP syndrome and thrombotic microangiopathy, thrombotic thrombocytopenic purpura and other 5 imitators. Eur J Obstet Gynecol Reprod Biol 2015; 189: 68-72 doi:10.1016/j.ejogrb.2015.03.017

• Zusätzliche Literatur

• e1 Boehlen F, Hohlfeld P, Extermann P. et al. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 2000; 95: 29-33 doi:10.1016/s0029-7844(99)00537-2
• e2 Maymon R, Strauss S, Vaknin Z. et al. Normal sonographic values of maternal spleen size throughout pregnancy. Ultrasound Med Biol 2006; 32: 1827-1831 doi:10.1016/j.ultrasmedbio.2006.06.017
• e3 Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J Obstet Gynecol 1990; 162: 731-734 doi:10.1016/0002-9378(90)90996-K
• e4 Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood 2017; 130: 2271-2277 doi:10.1182/blood-2017-05-781971
• e5 Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol 2012; 158: 3-15 doi:10.1111/j.1365-2141.2012.09135.x
• e6 Nisha S, Amita D, Uma S. et al. Prevalence and characterization of thrombocytopenia in pregnancy in Indian women. Indian J Hematol Blood Transfus 2012; 28: 77-81 doi:10.1007/s12288-011-0107-x
• e7 Wang X, Xu Y, Luo W. et al. Thrombocytopenia in pregnancy with different diagnoses. Med 2017; 96: e7561 doi:10.1097/MD.0000000000007561
• e8 Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009; 114: 1326-1331 doi:10.1097/AOG.0b013e3181c2bde8
• e9 Audia S, Mahévas M, Samson M. et al. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017; 16: 620-632 doi:10.1016/j.autrev.2017.04.012
• e10 Marini I, Bakchoul T. Pathophysiology of autoimmune thrombocytopenia: current insight with a focus on thrombopoiesis. Hamostaseologie 2019; 39: 227-237 doi:10.1055/s-0039-1678732
• e11 Terrell DR, Beebe LA, Vesely SK. et al. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol 2010; 85: 174-180 doi:10.1002/ajh.21616
• e12 Care A, Pavord S, Knight M. et al. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. BJOG 2018; 125: 604-612 doi:10.1111/1471-0528.14697
• e13 Webert KE, Mittal R, Sigouin C. et al. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102: 4306-4311 doi:10.1182/blood-2002-10-3317
• e14 Kelton JG, Steeves K. The amount of platelet-bound albumin parallels the amount of IgG on washed platelets from patients with immune thrombocytopenia. Blood 1983; 62: 924-927 doi:10.1182/blood.V62.4.924.924
• e15 Sareban N, Macher S, Drexler C. et al. Platelet antibody analysis by three different tests. J Clin Lab Anal 2015; 29: 198-202 doi:10.1002/jcla.21750
• e16 Lescale KB, Eddleman KA, Cines DB. et al. Antiplatelet antibody testing in thrombocytopenic pregnant women. Am J Obstet Gynecol 1996; 174: 1014-1018 doi:10.1016/s0002-9378(96)70342-3
• e17 Boehlen F, Hohlfeld P, Extermann P. et al. Maternal antiplatelet antibodies in predicting risk of neonatal thrombocytopenia. Obstet Gynecol 1999; 93: 169-173 doi:10.1016/s0029-7844(98)00390-1
• e18 Leonard A, Hittson Boal L, Pary P. et al. Identification of red blood cell antibodies in maternal breast milk implicated in prolonged hemolytic disease of the fetus and newborn. Transfusion 2019; 59: 1183-1189 doi:10.1111/trf.15154
• e19 Belkin A, Levy A, Sheiner E. Perinatal outcomes and complications of pregnancy in women with immune thrombocytopenic purpura. J Matern Fetal Neonatal Med 2009; 22: 1081-1085 doi:10.3109/14767050903029592
• e20 Fadiloglu E, Unal C, Tanacan A. et al. 5 yearsʼ experience of a tertiary center with thrombocytopenic pregnancies: gestational thrombocytopenia, idiopathic thrombocytopenic purpura and hypertensive disorders of pregnancy. Geburtsh Frauenheilk 2020; 80: 76-83 doi:10.1055/a-0865-4442
• e21 Yuce T, Acar D, Kalafat E. et al. Thrombocytopenia in pregnancy: do the time of diagnosis and delivery route affect pregnancy outcome in parturients with idiopathic thrombocytopenic purpura?. Int J Hematol 2014; 100: 540-544 doi:10.1007/s12185-014-1688-6
• e22 Sun D, Shehata N, Xiang YY. et al. Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy. Blood 2016; 128: 1329-1335 doi:10.1182/blood-2016-04-710285
• e23 Bjørn AM, Nielsen RB, Nørgaard M. et al. Risk of miscarriage among users of corticosteroid hormones: a population-based nested case-control study. Clin Epidemiol 2013; 5: 287-294 doi:10.2147/CLEP.S46893
• e24 Smith BT, Torday JS. Steroid administration in pregnant women with autoimmune thrombocytopenia. N Engl J Med 1982; 306: 744-745 doi:10.1056/NEJM198203253061214
• e25 Anderka M, Mitchell AA, Louik C. et al. National Birth Defects Prevention Study. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol 2012; 94: 22-30 doi:10.1002/bdra.22865
• e26 Carmichael SL, Shaw GM, Ma C. et al. National Birth Defects Prevention Study. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007; 197: 585.e1-585.e7 doi:10.1016/j.ajog.2007.05.046
• e27 Park-Wyllie L, Mazzotta P, Pastuszak A. et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62: 385-392 doi:10.1002/1096-9926(200012)62:6<385::aid-tera5>3.0.co;2-z
• e28 Pradat P, Robert-Gnansia E, Di Tanna GL. et al. Contributors to the MADRE database. First trimester exposure to corticosteroids and oral clefts. Birth Defects Res A Clin Mol Teratol 2003; 67: 968-970 doi:10.1002/bdra.10134
• e29 Christiaens GC, Nieuwenhuis HK, von dem Borne AE. et al. Idiopathic thrombocytopenic purpura in pregnancy: a randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count. Br J Obstet Gynaecol 1990; 97: 893-898 doi:10.1111/j.1471-0528.1990.tb02443.x
• e30 Nicolini U, Tannirandorn Y, Gonzalez P. et al. Continuing controversy in alloimmune thrombocytopenia: fetal hyperimmunoglobulinemia fails to prevent thrombocytopenia. Am J Obstet Gynecol 1990; 163 (4 Pt 1): 1144-1146 doi:10.1016/0002-9378(90)90674-v
• e31 Schoonen WM, Kucera G, Coalson J. et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol 2009; 145: 235-244 doi:10.1111/j.1365-2141.2009.07615.x
• e32 Valent P. Low blood counts: immune mediated, idiopathic, or myelodysplasia. Hematol Am Soc Hematol Educ Program 2012; 2012: 485-491 doi:10.1182/asheducation-2012.1.485
• e33 Baliakas P, Kättström M, Rossing M. et al. Refractory chronic “ITP”: When platelet size matters. Clin Case Rep 2018; 6: 1779-1780 doi:10.1002/ccr3.1711
• e34 Alami Z, Agier MS, Ahid S. et al. Pregnancy outcome following in utero exposure to azathioprine: A French comparative observational study. Therapie 2018; 73: 199-207 doi:10.1016/j.therap.2017.06.006
• e35 Alstead EM, Ritchie JK, Lennard-Jones JE. et al. Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 1990; 99: 443-446 doi:10.1016/0016-5085(90)91027-4oi
• e36 Reddy D, Murphy SJ, Kane SV. et al. Relapses of inflammatory bowel disease during pregnancy: in-hospital management and birth outcomes. Am J Gastroenterol 2008; 103: 1203-1209 doi:10.1111/j.1572-0241.2007.01756.x
• e37 Sukenik-Halevy R, Ellis MH. et al. Management of immune thrombocytopenic purpura in pregnancy. Obstet Gynecol Surv 2008; 63: 182-188 [gute Übersichtsarbeit]
• e38 Alter BP. Neonatal pancytopenia after maternal azathioprine therapy (letter). J Pediatr 1985; 106: 691 doi:10.1016/s0022-3476(85)80105-0
• e39 Davison JM, Dellagrammatikas H, Parkin JM. Maternal azathioprine therapy and depressed haemopoiesis in the babies of renal allograft patients. Br J Obstet Gynaecol 1985; 92: 233-239 doi:10.1111/j.1471-0528.1985.tb01088.x
• e40 DeWitte DB, Buick MK, Cyran SE. et al. Neonatal pancytopenia and severe combined immunodeficiency associated with antenatal administration of azathioprine and prednisone. J Pediatr 1984; 105: 625-628 doi:10.1016/s0022-3476(84)80435-7
• e41 Chakravaty E, Murray E, Kelman A. et al. Pregnancy outcomes in patients with autoimmune diseases treated with rituximab. Blood 2011; 117: 1499-1506 doi:10.1182/blood-2010-07-295444
• e42 Das G, Damotte V, Gelfand J. et al. Rituximab before and during pregnancy: A systematic review, and a case series in MS and NMOSD. Neurol Neuroimmunol Neuroinflamm 2018; 5: e453 doi:10.1212/NXI.0000000000000453
• e43 Donohoe F, Higgins M, Higgins S. et al. Rituximab – A novel therapy for severe ITP in pregnancy: A case report. Obstet Med 2019; 12: 196-198 doi:10.1177/1753495X18778489
• e44 Gall B, Yee A, Berry B. et al. Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura. J Obstet Gynaecol Can 2010; 32: 1167-1171 doi:10.1016/S1701-2163(16)34741-7
• e45 Kimby E, Sverrisdottir A, Elinder G. Safety of rituximab therapy during the first trimester of pregnancy: a case history. Eur J Haematol 2004; 72: 292-295 doi:10.1111/j.1600-0609.2004.00214.x
• e46 Klink DT, van Elburg RM, Schreurs MW. et al. Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clin Dev Immunol 2008; 2008: 271-363 doi:10.1155/2008/271363
• e47 Schmid J, Piroth D, Bührlen M. et al. Successful rituximab treatment of refractory immune thrombocytopenia during pregnancy. Onkologie 2011; 34 (Suppl. 06) 240 doi:10.1159/000333303
• e48 Simister NE. Placental transport of immunoglobulin G. Vaccine 2003; 21: 3365-3369 doi:10.1016/s0264-410x(03)00334-7
• e49 Gottlieb P, Axelsson O, Bakos O. et al. Splenectomy during pregnancy: an option in the treatment of autoimmune thrombocytopenic purpura. B J Obstet Gynaecol 1999; 106: 373-375 doi:10.1111/j.1471-0528.1999.tb08278.x
• e50 Anglin BV, Rutherford C, Ramus R. et al. Immune thrombocytopenic purpura during pregnancy: laparoscopic treatment. J Soc Laparoend Surg 2001; 5: 63-67
• e51 Griffiths J, Sia W, Shapiro AM. et al. Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. J Obstet Gynaecol Can 2005; 27: 771-774 doi:10.1016/s1701-2163(16)30729-0
• e52 Varghese L, Viswabandya A, Mathew AJ. Dapsone, danazol, and intrapartum splenectomy in refractory ITP complicating pregnancy. Indian J Med Sci 2008; 62: 452-455 doi:10.4103/0019-5359.44483
• e53 Elezovic I, Boskovic D, Tomin D. et al. Cesarean section combined with splenectomy in severely resistant immune thrombocytopenia. Acta Chir Iugosl 2002; 49: 51-54 doi:10.2298/aci0203051e [Article in Croatian, Abstract English]
• e54 Mahey R, Kaur SD, Chumber S. et al. Splenectomy during pregnancy: treatment of refractory immune thrombocytopenic purpura. BMJ Case Rep 2013; DOI: 10.1136/bcr-2013-201778.
• e55 Bleau N, Czuzoj-Shulman N, Spence AR. et al. Safety of splenectomy during pregnancy. J Matern Fetal Neonatal Med 2017; 30: 1671-1675 doi:10.1080/14767058.2016.1222365
• e56 Fujimura K, Harada Y, Fujimoto T. et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int J Hematol 2002; 75: 426-433 doi:10.1007/bf02982137
• e57 Payne SD, Resnik R, Moore TR. et al. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial haemorrhage in pregnancies complicated by autoimmune thrombocytopenia. Am J Obstet Gynecol 1997; 177: 149-155 doi:10.1016/S0002-9378(97)70454-X
• e58 Samuels P, Bussel JB, Braitman LE. et al. Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura. N Engl J Med 1990; 323: 229-235 doi:10.1056/NEJM1990072632304045359.44483
• e59 Ferrer P, Roberts I, Sydenham E. et al. Antifibrinolytic agents in post partum haemorrhage: a systematic review. BMC Pregnancy Childbirth 2009; 9: 29 doi:10.1186/1471-2393-9-29
• e60 Sentilhes L, Winer N, Azria E. et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med 2018; 379: 731-742 doi:10.1056/NEJMoa1800942
• e61 WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-2106 doi:10.1016/S0140-6736(17)30638-4
• e62 Dunphy L, Williams R. Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. BMJ Case Rep 2019; DOI: 10.1136/bcr-2018-228309.
• e63 Mannucci PM. Hemostatic Drugs. N Engl J Med 1998; 339: 245-253 doi:10.1056/NEJM199807233390407
• e64 Alkaabi JK, Alkindi S, Al Riyami N. et al. Successful treatment of severe thrombocytopenia with romiplostim in a pregnant patient with systemic lupus erythematosus. Lupus 2012; 21: 1571-1574 doi:10.1177/0961203312463621
• e65 Chua SJ, Morton MR, Svigos J. et al. Use of romiplostim in pregnancy for refractory idiopathic thrombocytopenic purpura: two case reports with maternal and fetal outcomes and literature review. Obstet Med 2018; DOI: 10.1177/1753495X18773960.
• e66 Decroocq J, Marcellin L, Le Ray C. et al. Rescue therapy with romiplostim for refractory primary immune thrombocytopenia during pregnancy. Obstet Gynecol 2014; 124: 481-483 doi:10.1097/AOG.0000000000000371
• e67 Favier R, De Carne C, Elefant E. et al. Eltrombopag to treat thrombocytopenia during last month of pregnancy in a woman with MYH9-related disease: a case report. A A Pract 2018; 10: 10-12 doi:10.1213/XAA.0000000000000621
• e68 Ferreira IJMCF, Sousa F, Vasco EM. et al. Severe immune thrombocytopenia in pregnancy treated with eltrombopag – a case report. J Gynecol Obstet Hum Reprod 2018; 47: 405-408 doi:10.1016/j.jogoh.2018.06.010
• e69 Harrington P, Nelson-Piercy C, Williamson C. et al. Refractory severe immune thrombocytopenia in a twin pregnancy. Obstet Med 2018; 11: 35-38 doi:10.1177/1753495X17709188 [keine Ansprache auf Romiplostim]
• e70 Patil AS, Dotters-Katz SK, Metjian AD. et al. Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy. Obstet Gynecol 2013; 122: 483-485 doi:10.1097/AOG.0b013e31828d5b56
• e71 Purushothaman J, Puthumana KJ, Kumar A. et al. A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag. Asian J Transfus Sci 2016; 10: 155-158 doi:10.4103/0973-6247.177204
• e72 Rosa María RN, Laura RL, Ángeles PB. et al. Use of Romiplostim during pregnancy as a rescue therapy in primary immune thrombocytopenia: Literature review and case description. Platelets 2020; 31: 403-406 doi:10.1080/09537104.2019.1615613
• e73 Suzuki N, Hiraga J, Hariyama Y. et al. A low birth weight infant with no malformations delivered by a primary immune thrombocytopenia patient treated with eltrombopag. Int J Hematol 2018; 108: 109-111 doi:10.1007/s12185-017-2383-1
• e74 Godeau B, Durand JM, Roudot-Thoraval F. et al. Dapsone for chronic autoimmune thrombocytopenic purpura: a report of 66 cases. Br J Haematol 1997; 97: 336-339 doi:10.1046/j.1365-2141.1997.412687.x
• e75 Brabin BJ, Eggelte TA, Parise M. et al. Dapsone therapy for malaria during pregnancy: maternal and fetal outcomes. Drug Saf 2004; 27: 633-648 doi:10.2165/00002018-200427090-00002
• e76 Lush R, Iland H, Peat B. et al. Successful use of dapsone in refractory pregnancy-associated idiopathic thrombocytopenic purpura. Aust N Z J Med 2000; 30: 105-107 doi:10.1111/j.1445-5994.2000.tb01075.x
• e77 Veneri D, Franchini M, Raffaelli R. et al. Idiopathic thrombocytopenic purpura in pregnancy: Analysis of 43 consecutive cases followed at a single Italian institution. Ann Hematol 2006; 85: 552-554 doi:10.1007/s00277-006-0120-6
• e78 Gilmore KS, McLintock C. Maternal and fetal outcomes of primary immune thrombocytopenia during pregnancy: A retrospective study. Obstet Med 2018; 11: 12-16 doi:10.1177/1753495X17727408
• e79 Carroli G, Cuesta C, Abalos E. et al. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22: 999-1012 doi:10.1016/j.bpobgyn.2008.08.004
• e80 Dupont C, Rudigoz RC, Cortet M. et al. Frequency, causes and risk factors of postpartum haemorrhage: a population-based study in 106 French maternity units. J Gynecol Obstet Biol Reprod (Paris) 2014; 43: 244-253 doi:10.1016/j.jgyn.2013.05.003
• e81 Aiyelaagbe S, Hobson M, Byrd LM. et al. Outcomes in women with thrombocytopenia in pregnancy. Arch Dis Child Fetal Neonatal Ed 2014; 99: A1-A180 doi:10.1136/archdischild-2014-306576.381
• e82 Khaspekova SG, Shustova ON, Golubeva NV. et al. Circulating antiplatelet antibodies in pregnant women with immune thrombocytopenic purpura as predictors of thrombocytopenia in the newborns. Platelets Platelets 2019; 30: 1008-1012 doi:10.1080/09537104.2018.1557615
• e83 Kawaguchi K, Matsubara K, Takafuta T. et al. Factors predictive of neonatal thrombocytopenia in pregnant women with immune thrombocytopenia. Int J Hematol 2014; 99: 570-576 doi:10.1007/s12185-014-1562-6
• e84 Koyama S, Tomimatsu T, Kanagawa T. et al. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol 2012; 87: 15-21 doi:10.1002/ajh.22178
• e85 Subbaiah M, Kumar S, Roy KK. et al. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura. Arch Gynecol Obstet 2014; 289: 269-273 doi:10.1007/s00404-013-2958-x
• e86 van der Lugt NM, van Kampen A, Walther FJ. et al. Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic. Vox Sang 2013; 105: 236-243 doi:10.1111/vox.12036
• e87 van Veen JJ, Nokes TJ, Makris M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol 2010; 148: 15-25 doi:10.1111/j.1365-2141.2009.07899.x
• e88 Lee LO, Bateman BT, Kheterpal S. et al. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients: a report from the multicentre perioperative outcomes group. Anesthesiology 2017; 126: 1053-1063 doi:10.1097/ALN.0000000000001630