Immune Thrombocytopenia and Pregnancy Follow-up

Updated: Oct 09, 2015
  • Author: Muhammad A Mir, MD, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Follow-up

Transfer

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  • 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

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  • 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. [52]

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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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