Download PDF
Semin Thromb Hemost 2006; 32(4): 422-429
DOI: 10.1055/s-2006-942763
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Essential Thrombocythemia/Polycythemia Vera and Pregnancy: The Need for an Observational Study in Europe

Martin Griesshammer1 , Sabine Struve2 , Claire M. Harrison2
  • 1Department of Medicine III, Medizinische Universitätsklinik, Ulm, Germany
  • 2Department of Haematology, Guy's and St. Thomas' Foundation Trust, St. Thomas' Hospital, London, United Kingdom
Further Information

Publication History

Publication Date:
29 June 2006 (online)

    Permissions and Reprints

ABSTRACT

The management of pregnant patients with essential thrombocythemia (ET) and polycythemia vera (PV) may be problematic. In the literature there are ~300 cases of pregnancies reported in ET and less than 50 pregnancies reported in PV. To reduce the effect of reporting bias, we selected articles with either > 10 pregnancies or at least six patients, and here report on the outcome of 195 pregnancies in ET and 36 pregnancies in PV patients. The live birth rate was ~60% in ET and 58% in PV. Spontaneous abortion during the first trimester was the most frequent fetal complication, occurring in 31% of ET pregnancies and in 22% of PV pregnancies, respectively. Major maternal complications were more frequent in PV compared with ET (44.4 versus 7.7%). Treatment with low-dose aspirin during pregnancy in ET seemed to reduce complications and also seemed beneficial during pregnancy in PV. In high-risk pregnancies, the additional use of low molecular weight heparin and/or interferon α should be considered. This article also describes a registry for an observational study concerning pregnancy in chronic Philadelphia chromosome-negative myeloproliferative disorders within the European LeukemiaNet. A potential management algorithm for pregnancies in ET or PV is also provided.

KEYWORDS

Essential thrombocythemia - polycythemia vera - pregnancy - observational study - European LeukemiaNet

REFERENCES

  • 1 McNally R J, Roman E, Cartwright R A. Leukemias and lymphomas: time trends in the UK, 1984-93.  Cancer Causes Control. 1999;  10(1) 35-42
    CrossrefPubMedGoogle Scholar
  • 2 Finazzi G, Harrison C. Essential thrombocythemia.  Semin Hematol. 2005;  42(4) 230-238
    CrossrefPubMedGoogle Scholar
  • 3 Bates S M, Ginsberg J S. Thrombosis in pregnancy.  Curr Opin Hematol. 1997;  4(5) 335-343
    PubMedGoogle Scholar
  • 4 Bangerter M, Guthner C, Beneke H, Hildebrand A, Grunewald M, Griesshammer M. Pregnancy in essential thrombocythaemia: treatment and outcome of 17 pregnancies.  Eur J Haematol. 2000;  65(3) 165-169
    CrossrefPubMedGoogle Scholar
  • 5 Beard J, Hillmen P, Anderson C C, Lewis S M, Pearson T C. Primary thrombocythaemia in pregnancy.  Br J Haematol. 1991;  77(3) 371-374
    PubMedGoogle Scholar
  • 6 Beressi A H, Tefferi A, Silverstein M N, Petitt R M, Hoagland H C. Outcome analysis of 34 pregnancies in women with essential thrombocythemia.  Arch Intern Med. 1995;  155(11) 1217-1222
    CrossrefPubMedGoogle Scholar
  • 7 Griesshammer M, Grunewald M, Michiels J J. Acquired thrombophilia in pregnancy: essential thrombocythemia.  Semin Thromb Hemost. 2003;  29(2) 205-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Griesshammer M, Heimpel H, Pearson T C. Essential thrombocythemia and pregnancy.  Leuk Lymphoma. 1996;  22(suppl 1) 57-63
    PubMedGoogle Scholar
  • 9 Harrison C. Pregnancy and its management in the Philadelphia negative myeloproliferative diseases.  Br J Haematol. 2005;  129(3) 293-306
    CrossrefPubMedGoogle Scholar
  • 10 Niittyvuopio R, Juvonen E, Kaaja R et al.. Pregnancy in essential thrombocythaemia: experience with 40 pregnancies.  Eur J Haematol. 2004;  73(6) 431-436
    CrossrefPubMedGoogle Scholar
  • 11 Robinson S, Bewley S, Hunt B J, Radia D H, Harrison C N. The management and outcome of 18 pregnancies in women with polycythemia vera.  Haematologica. 2005;  90(11) 1477-1483
    PubMedGoogle Scholar
  • 12 Taylor U B, Bardeguez A D, Iglesias N, Gascon P. Idiopathic myelofibrosis in pregnancy: a case report and review of the literature.  Am J Obstet Gynecol. 1992;  167(1) 38-39
    PubMedGoogle Scholar
  • 13 Gotic M, Cvetkovic M, Bozanovic T, Cemerikic V. Successful treatment of primary myelofibrosis with thrombocytosis during pregnancy with alfa-interferon.  Srp Arh Celok Lek. 2001;  129(11-12) 304-308
    PubMedGoogle Scholar
  • 14 Hoagland H C, Silverstein M N. Primary thrombocythemia in the young patient.  Mayo Clin Proc. 1978;  53(9) 578-580
    PubMedGoogle Scholar
  • 15 Pagliaro P, Arrigoni L, Muggiasca M L, Poggio M, Russo U, Rossi E. Primary thrombocythemia and pregnancy: treatment and outcome in fifteen cases.  Am J Hematol. 1996;  53(1) 6-10
    CrossrefPubMedGoogle Scholar
  • 16 Vantroyen B, Vanstraelen D. Management of essential thrombocythemia during pregnancy with aspirin, interferon alpha-2a and no treatment. A comparative analysis of the literature.  Acta Haematol. 2002;  107(3) 158-169
    CrossrefPubMedGoogle Scholar
  • 17 Wright C A, Tefferi A. A single institutional experience with 43 pregnancies in essential thrombocythemia.  Eur J Haematol. 2001;  66(3) 152-159
    CrossrefPubMedGoogle Scholar
  • 18 Zahner J, Wehmeier A, Schneider W. Pregnancy in essential thrombocythemia. Manifestation time and risk for mother and child [In German].  Dtsch Med Wochenschr. 1995;  120(44) 1517-1523
    PubMedGoogle Scholar
  • 19 Bellucci S, Janvier M, Tobelem G et al.. Essential thrombocythemias. Clinical evolutionary and biological data.  Cancer. 1986;  58(11) 2440-2447
    PubMedGoogle Scholar
  • 20 Leone G, De Stefano V, D'Addosio A. Essential thrombocythemia: pregnancy.  Haematologica. 1991;  76(suppl 3) 365-367
    PubMedGoogle Scholar
  • 21 Randi M L, Rossi C, Fabris F, Girolami A. Essential thrombocythemia in young adults: treatment and outcome of 16 pregnancies.  J Intern Med. 1999;  246(5) 517-518
    CrossrefPubMedGoogle Scholar
  • 22 Cairns J W, Mahon A, Waters D A, Chanarin I. Platelet levels in pregnancy.  J Clin Pathol. 1977;  30(4) 392
    PubMedGoogle Scholar
  • 23 Sejeny S A, Eastham R D, Baker S R. Platelet counts during normal pregnancy.  J Clin Pathol. 1975;  28(10) 812-813
    CrossrefPubMedGoogle Scholar
  • 24 Chow E Y, Haley L P, Vickars L M. Essential thrombocythemia in pregnancy: platelet count and pregnancy outcome.  Am J Hematol. 1992;  41(4) 249-251
    PubMedGoogle Scholar
  • 25 Cincotta R, Higgins J R, Tippett C et al.. Management of essential thrombocythaemia during pregnancy.  Aust NZ J Obstet Gynaecol. 2000;  40(1) 33-37
    PubMedGoogle Scholar
  • 26 Randi M L, Rossi C, Fabris F, Girolami A. Essential thrombocythemia in young adults: major thrombotic complications and complications during pregnancy-a follow-up study in 68 patients.  Clin Appl Thromb Hemost. 2000;  6(1) 31-35
    PubMedGoogle Scholar
  • 27 Hunt B J, Doughty H A, Majumdar G et al.. Thromboprophylaxis with low molecular weight heparin (Fragmin) in high risk pregnancies.  Thromb Haemost. 1997;  77(1) 39-43
    PubMedGoogle Scholar
  • 28 Hunt B J, Gattens M, Khamashta M, Nelson-Piercy C, Almeida A. Thromboprophylaxis with unmonitored intermediate-dose low molecular weight heparin in pregnancies with a previous arterial or venous thrombotic event.  Blood Coagul Fibrinolysis. 2003;  14(8) 735-739
    PubMedGoogle Scholar
  • 29 Gris J C, Mercier E, Quere I et al.. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder.  Blood. 2004;  103(10) 3695-3699
    CrossrefPubMedGoogle Scholar
  • 30 Sanson B J, Lensing A W, Prins M H et al.. Safety of low-molecular-weight heparin in pregnancy: a systematic review.  Thromb Haemost. 1999;  81(5) 668-672
    PubMedGoogle Scholar
  • 31 Petit J J, Callis M, Fernandez de Sevilla A. Normal pregnancy in a patient with essential thrombocythemia treated with interferon-alpha 2b.  Am J Hematol. 1992;  40(1) 80
    PubMedGoogle Scholar
  • 32 Thornley S, Manoharan A. Successful treatment of essential thrombocythemia with alpha interferon during pregnancy.  Eur J Haematol. 1994;  52(1) 63-64
    PubMedGoogle Scholar
  • 33 Williams J M, Schlesinger P E, Gray A G. Successful treatment of essential thrombocythaemia and recurrent abortion with alpha interferon.  Br J Haematol. 1994;  88(3) 647-648
    PubMedGoogle Scholar
  • 34 Pulik M, Lionnet F, Genet P, Petitdidier C, Jary L. Platelet counts during pregnancy in essential thrombocythaemia treated with recombinant alpha-interferon.  Br J Haematol. 1996;  93(2) 495
    PubMedGoogle Scholar
  • 35 Shpilberg O, Shimon I, Sofer O, Dolitski M, Ben-Bassat I. Transient normal platelet counts and decreased requirement for interferon during pregnancy in essential thrombocythaemia.  Br J Haematol. 1996;  92(2) 491-493
    CrossrefPubMedGoogle Scholar
  • 36 Schmidt H H, Neumeister P, Kainer F, Karpf E F, Linkesch W, Sill H. Treatment of essential thrombocythemia during pregnancy: antiabortive effect of interferon-alpha?.  Ann Hematol. 1998;  77(6) 291-292
    CrossrefPubMedGoogle Scholar
  • 37 Kumar A R, Hale T W, Mock R E. Transfer of interferon alfa into human breast milk.  J Hum Lact. 2000;  16(3) 226-228
    CrossrefPubMedGoogle Scholar
  • 38 Doll D C, Ringenberg Q S, Yarbro J W. Antineoplastic agents and pregnancy.  Semin Oncol. 1989;  16(5) 337-346
    PubMedGoogle Scholar
  • 39 Falconer J, Pineo G, Blahey W, Bowen T, Docksteader B, Jadusingh I. Essential thrombocythemia associated with recurrent abortions and fetal growth retardation.  Am J Hematol. 1987;  25(3) 345-347
    CrossrefPubMedGoogle Scholar
  • 40 Mercer B, Drouin J, Jolly E, d'Anjou G. Primary thrombocythemia in pregnancy: a report of two cases.  Am J Obstet Gynecol. 1988;  159(1) 127-128
    PubMedGoogle Scholar
  • 41 Koh L P, Devendra K, Tien S L. Four pregnancies in two patients with essential thrombocythaemia-a case report.  Ann Acad Med Singapore. 2002;  31(3) 353-356
    PubMedGoogle Scholar
  • 42 Horlocker T T, Wedel D J. Spinal and epidural blockade and perioperative low molecular weight heparin: smooth sailing on the Titanic.  Anesth Analg. 1998;  86(6) 1153-1156
    PubMedGoogle Scholar
  • 43 Checketts M R, Wildsmith J A. Central nerve block and thromboprophylaxis-is there a problem?.  Br J Anaesth. 1999;  82(2) 164-167
    CrossrefPubMedGoogle Scholar
  • 44 Willoughby S J, Fairhead S, Woodcock B E, Pearson T C. Postpartum thrombosis in primary thrombocythaemia.  Eur J Haematol. 1997;  59(2) 121-123
    PubMedGoogle Scholar
  • 45 Michiels J J. Essential thrombocythemia is not associated with postpartum thrombosis or increased risk of venous thrombosis.  Eur J Haematol. 1998;  60 138-139
    PubMedGoogle Scholar

 Professor
M GriesshammerM.D. Ph.D. 

Department of Medicine III, Medizinische Universitätsklinik

Robert-Koch-Strasse 8, D-89081 Ulm, Germany

Email: martin.griesshammer@medizin.uni-ulm.de

      >