Differentialdiagnose der Thrombozytopenien in der Schwangerschaft

Zusammenfassung

Die Inzidenz der Thrombozytopenie in der Schwangerschaft (< 150 000/µl) liegt zwischen 7 % und 8 %; bei etwa 75 % der Schwangeren mit einer Thrombozytopenie handelt es sich um eine benigne Gestationsthrombozytopenie. Die immunologisch bedingten Thrombozytopenien (autoimmune und alloimmune Thrombozytopenie) sind von besonderem Interesse, da hieraus eine fetale oder neonatale Thrombozytopenie resultieren kann. Die ITP ist gekennzeichnet durch Autoantikörper der Klasse IgG gegen zirkulierenden Thrombozyten und ihre Vorstufen. Hirnblutungen, hervorgerufen durch eine vaginale Geburt, sind extrem selten, eine Indikation zur primären Sectio caesarea ist nicht gegeben. Die neonatale Alloimmunthrombozytopenie ist Folge einer fetomaternale Thrombozyteninkompatibilität. Bei den erkrankten Kindern kommt es in 10-20 % der Fälle zu intrakraniellen Blutungen, die in bis zu 25-50 % der Fälle bereits in utero entstanden sind. Das unkalkulierbar verlaufende HELLP-Syndrom tritt mehrheitlich im III. Trimenon (Median34. SSW) auf. Die Thrombotisch-thrombozytopenische Purpura (TTP) und das Hämolytisch-urämische-Syndrom (HUS) gehören zu den primären thrombotischen Mikroangiopathien. Die TTP tritt in der Mehrzahl Fälle antepartal (bis zur 24. SSW) auf, das HUS entwickelt sich typischerweise einige Tage bis zu 10 Wochen nach normaler Schwangerschaft und Geburt. Eine Heparin-induzierte Thrombozytopenie mit Verminderung vorher normwertiger Blutplättchen auf < 150 000/µl bzw um ≥ 50 % des Ausgangswertes ist die wichtigste Komplikation einer Heparingabe.

Differential diagnosis of thrombocytopenia in pregnancy

Summary

Thrombocytopenia (< 150 000/µl) is a common finding, occurring in 7-8 % of pregnancies. Some conditions, such as gestational thrombocytopenia pose no maternal or fetal risks. Idiopathic thrombocytopenic purpura (ITP) is an acquired haematologic disorder, common among children and adults, with unknown etiology and autoimmune pathogenesis. The incidence of severe fetal and neonatal thrombocytopenia is very rare, and neonatal intracranial hemorrhage is unlikely to be related to the mode of delivery. Alloimmune thrombocytopenia occurs with an incidence of 1/1,000 livebirths and is induced by a maternal alloimmunization against fetal platelet antigens. The incidence of intracranial haemorrhage in the fetus and neonate is the highest for any immune thrombocytopenia. The HELLP syndrome is a severe, unpredictable and life-threatening complication of preeclampsia, characterized by a triad of hemolysis, elevated liver enzymes and low platelet counts. HELLP syndrome develops in the third trimester but can occur postpartum. Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are syndromes of microangiopathic hemolytic anemia, and thrombocytopenia. During pregnancy, TTP usually presents in the second trimester, whereas HUS develops in the postpartum period. Heparin-induced thrombocytopenia type II is a serious, immune-mediated complication of heparin therapy.

MeSH

C.13.703.799.314.309
C.13.703 pregnancy complications

Schlüsselwörter

Thrombozytopenie - Schwangerschaft - Differentialdiagnose - HELLP-Syndrome - Heparin-induzierte Thrombozytopenie

Key words

Thrombocytopenia - pregnancy - diiferential diagnosis - HELLP syndrome - heparin-induced thrombocytopenia

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