Terry Gernsheimer1, Keith R McCrae. 1. University of Washington and Puget Sound Blood Center, Seattle, Washington 98104, USA. bldbuddy@u.washington.edu
Abstract
PURPOSE OF REVIEW: This review assesses the need for revision of the present guidelines for immune thrombocytopenic purpura in pregnancy based on evidence-based data from published articles of relevance. RECENT FINDINGS: The American Society of Hematology (ASH) and British Committee for Standards in Haematology (BCSH) guidelines indicate that at platelet counts below 70,000 or 80,000/microl, respectively, causes of thrombocytopenia other than gestational thrombocytopenia should be considered. The ASH guidelines indicate that for severe thrombocytopenia or thrombocytopenic bleeding in the third trimester, intravenous immunoglobulin is an appropriate first-line agent. No consensus was reached concerning the use of intravenous immunoglobulin or corticosteroids as first-line therapy at other gestational periods. Splenectomy is considered acceptable for patients with refractory immune thrombocytopenic purpura and severe thrombocytopenia with bleeding only in the second trimester. Laparoscopic splenectomy can be safely performed during pregnancy. The BCSH guidelines are consistent with contemporary practice in recommending that the mode of delivery of a pregnant patient with immune thrombocytopenic purpura should be determined based on maternal indications. Screening of articles published since the formulation of the BCSH guidelines in 2003 did not reveal new data that would lead to significant revisions in the guidelines. SUMMARY: Though outdated in some aspects, the ASH and BCSH guidelines still provide a useful framework for management of pregnant patients with immune thrombocytopenic purpura.
PURPOSE OF REVIEW: This review assesses the need for revision of the present guidelines for immune thrombocytopenic purpura in pregnancy based on evidence-based data from published articles of relevance. RECENT FINDINGS: The American Society of Hematology (ASH) and British Committee for Standards in Haematology (BCSH) guidelines indicate that at platelet counts below 70,000 or 80,000/microl, respectively, causes of thrombocytopenia other than gestational thrombocytopenia should be considered. The ASH guidelines indicate that for severe thrombocytopenia or thrombocytopenic bleeding in the third trimester, intravenous immunoglobulin is an appropriate first-line agent. No consensus was reached concerning the use of intravenous immunoglobulin or corticosteroids as first-line therapy at other gestational periods. Splenectomy is considered acceptable for patients with refractory immune thrombocytopenic purpura and severe thrombocytopenia with bleeding only in the second trimester. Laparoscopic splenectomy can be safely performed during pregnancy. The BCSH guidelines are consistent with contemporary practice in recommending that the mode of delivery of a pregnant patient with immune thrombocytopenic purpura should be determined based on maternal indications. Screening of articles published since the formulation of the BCSH guidelines in 2003 did not reveal new data that would lead to significant revisions in the guidelines. SUMMARY: Though outdated in some aspects, the ASH and BCSH guidelines still provide a useful framework for management of pregnant patients with immune thrombocytopenic purpura.