Immune Thrombocytopenia and Pregnancy Follow-up

  • Author: Lynnae Millar; Chief Editor: David Chelmow, MD   more...
 
Updated: Jan 10, 2012
 

Transfer

  • Pregnant women with significant thrombocytopenia should deliver where blood products, including platelets, are available.
  • Pregnant women at risk to deliver a newborn with severe thrombocytopenia should deliver at an institution capable of caring for the newborn. In general, a hospital with a level III NICU is necessary to provide an appropriate level of care.
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Deterrence/Prevention

  • Some investigators have suggested that all pregnant women presenting for prenatal care be typed for platelet alloantigen to determine if they are at risk for NAIT. A comparison of the effectiveness of this type of screening program estimated a cost of $45,000 per case of alloimmunization diagnosed in whites. The cost would be higher if testing were initiated in women in other ethnic groups because the rate of NAIT is lower in nonwhite women. At present, universal prenatal screening is not recommended because a clear clinical benefit has not been demonstrated.
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Complications

  • Women and newborns with severe thrombocytopenia can experience intracranial and intra-abdominal bleeding. This can result in significant morbidity, including neurologic damage and/or death.
  • Women requiring long-term steroid therapy can develop complications from the medication exposure.
  • Transfusion of blood products can result in transfusion reactions in the recipient. With current blood bank crossmatching, significant transfusion reactions are rare. Additionally, a risk of transmission of viral infections, especially hepatitis and human immunodeficiency virus, exists.
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Prognosis

  • Women with ITP generally do well in pregnancy. ITP is an autoimmune disease and exacerbations, and remissions are common. Pregnancy does not appear to affect the course of the disease.
  • Fetuses and newborns with NAIT can experience permanent neurologic sequelae, organ damage, and death from intracranial and intra-abdominal bleeds due to severe thrombocytopenia. However, after birth, maternal antibodies are fairly rapidly degraded and the thrombocytopenia resolves.
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Contributor Information and Disclosures
Author

Lynnae Millar  MD, Professor, Chair, Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii

Lynnae Millar is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Wadie F Bahou, MD  Chief, Division of Hematology, Hematology/Oncology Fellowship Director, Professor, Department of Internal Medicine, State University of New York at Stony Brook

Wadie F Bahou, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making

Disclosure: Nothing to disclose.

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Immune thrombocytopenia. Nonstress test 1 week before delivery showing a normal reactive fetal heart rate pattern.
Immune thrombocytopenia. Nonstress test 4 days before delivery showing a reactive fetal heart rate with an unusual pseudosinusoidal pattern that lasted 9 minutes.
Immune thrombocytopenia. Neonatal brain at autopsy showing extensive subdural hemorrhage.
Immune thrombocytopenia. Neonatal spine at autopsy showing extensive hemorrhage at base of spine.
Immune thrombocytopenia. An infant born with neonatal lupus syndrome and severe thrombocytopenia. Note extensive bruising and petechiae.
Immune thrombocytopenia. An infant born with a cephalohematoma.
 
 
 
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