Idiopathic Thrombocytopenic Purpura (ITP) ITP is an autoimmune condition where a woman’s immune system attacks and destroys her own platelets. Women diagnosed with ITP before pregnancy are managed similarly until the end of the third trimester, typically with glucocorticoids (steroids) as necessary, and avoiding splenectomy, if possible.
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How is immune thrombocytopenic purpura treated in pregnancy?
Medical Care. In pregnancy, treatment for immune thrombocytopenic purpura (ITP) and neonatal alloimmune thrombocytopenia (NAIT) involves two patients: the mother and the fetus. In cases of ITP, care of the mother centers on minimizing her risk of bleeding during pregnancy and childbirth.
What is the treatment for ITP in pregnancy?
Though treatment of the pregnant woman with ITP generally does not differ significantly from that of non-pregnant individuals, there are some unique considerations [39-42]. Due to their efficacy and low cost, many consider corticosteroids to be first line treatment for ITP in pregnancy [10,14,36].
What are the neonatal complications of immune thrombocytopenic purpura (ITP)?
The major neonatal concern in ITP is the risk of fetal or newborn intracranial or visceral hemorrhage due to severe thrombocytopenia. Newborn thrombocytopenia is difficult to predict because newborn platelet counts do not always correlate with maternal platelet countsor antiplatelet antibody titers.
What is included in preconception counseling for immune thrombocytopenia (ITP)?
Women who have been diagnosed with immune thrombocytopenia (ITP) prior to pregnancy should be offered preconception counseling. For the counseling session, it is necessary to obtain details of her case, including the presentation of ITP, prior medical treatment, whether splenectomy was performed, and response to treatment.
Can ITP be passed to baby from mother?
Could my baby be affected by my ITP? You cannot pass on ITP as it is not an inherited condition. However it is possible that the antibodies in your blood may enter your baby's blood (even if your platelet count is now normal following splenectomy).
How is ITP treated during pregnancy?
IVIg and low-dose corticosteroids comprise the mainstays of treatment in ITP, but high doses of corticosteroids or prolonged corticosteroid therapy are associated with significant toxicity in the pregnant patient and should be avoided.
Can I have a baby if I have ITP?
ITP is not a contraindication for pregnancy; women with a history of ITP should not be discouraged from becoming pregnant as their ITP can be safely managed with close monitoring and multidisciplinary coordination with obstetrics and pediatrics.
Can ITP antibodies cross placenta?
Management of ITP during pregnancy is complex because of large differences between maternal and fetal platelet counts. The circulating antibodies can cross the placenta and cause a neonatal passive immune thrombocytopenia that may increase the risk of cerebral haemorrhage in the newborn infant.
Can you do IVIG while pregnant?
Yes. In fact, most patients are on other disease-specific therapies in conjunction with IVIG therapy. Is IVIG therapy safe during pregnancy? IVIG therapy is safe to receive during pregnancy and is often administered after delivery to deter relapse events that may occur in the post-partum period.
Can you have IVIG when pregnant?
IVIG Use During Pregnancy IVIG is used in pregnancy to treat obstetrical and non–obstetrical-related conditions.
Can thrombocytopenia affect pregnancy?
The physiological thrombocytopenia of pregnancy is mild and has no adverse effects for the mother and fetus. By contrast, a significant thrombocytopenia associated with medical conditions can have serious maternal-fetal consequences and requires specific monitoring and appropriate management.
What causes ITP in babies?
ITP is caused by the body's own immune system mistakenly destroying platelets, and is often triggered by the common cold. If a child has a shortage of platelets, then they will bruise easily and may have other bleeding problems. One in 10,000 children have ITP, so it is quite rare.
Is ITP inherited?
Currently, ITP is not usually considered an inherited disease. If multiple family members have been diagnosed with ITP, the hematologist should verify that the cause of low platelets is truly autoimmune and is not due to an inherited disorder that affects platelet production.
Can ITP cause miscarriage?
Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births.
What is thrombocytopenic purpura?
Idiopathic thrombocytopenic purpura is a blood disorder characterized by an abnormal decrease in the number of platelets in the blood. A decrease in platelets can result in easy bruising, bleeding gums, and internal bleeding. ITP may be acute and resolve in less than 6 months, ...
What is the difference between purpura and thrombocytopenia?
Thrombocytopenia means a decreased number of platelets in the blood. Purpura refers to the purple discoloring of the skin, as with a bruise. ITP is a fairly common blood disorder that both children and adults can develop. There are two forms of ITP: Acute thrombocytopenic purpura.
How long does ITP last?
ITP may be acute and resolve in less than 6 months, or chronic and last longer than 6 months. Treatment options include a variety of medications that can reduce the destruction of platelets or increase their production. In some cases, surgery to remove the spleen is necessary.
How long does it take for ITP to go away?
There are two forms of ITP: Acute thrombocytopenic purpura. This usually affects young children, ages 2 to 6 years old. The symptoms may follow a viral illness, such as chickenpox. Acute ITP usually starts suddenly and the symptoms usually disappear in less than 6 months, often within a few weeks.
What is the normal platelet count for thrombocytopenic purpura?
What are the symptoms of idiopathic thrombocytopenic purpura? Normal platelet count is in the range of 150,000 to 450,000. With ITP, the platelet count is less than 100,000. By the time significant bleeding occurs, you may have a platelet count of less than 10,000.
What happens if ITP is a medication?
Medication changes. If it is a medication that is the suspected cause, discontinuation or changing the medication may be necessary. Infection treatment. If infection is the cause for ITP, then treatment of the infection may result in higher platelet counts. Splenectomy.
How long does thrombocytopenic purpura last?
Chronic thrombocytopenic purpura. The onset of the disorder can happen at any age, and the symptoms can last a minimum of 6 months, several years , or a lifetime. Adults have this form more often than children do, but it does affect adolescents. Females have it more often than males.
What level of care is needed for a newborn with thrombocytopenia?
In general, a hospital with a level III neonatal intensive care unit (NICU) is necessary to provide an appropriate level of care.
How often should ITP be seen?
Clinical management of pregnancy-associated ITP is a complex task requiring close collaboration by the obstetrician, hematologist, and anesthetist. Pregnant women with ITP should be seen monthly in the first and second trimester, every 2 weeks after 28 weeks, and weekly after 36 weeks.
What is ITP counseling?
Women who have been diagnosed with immune thrombocytopenia (ITP) prior to pregnancy should be offered preconception counseling. For the counseling session, it is necessary to obtain details of her case, including the presentation of ITP, prior medical treatment, whether splenectomy was performed, and response to treatment. In addition, an obstetric history should be obtained; in women who have previously given birth, this should include the neonatal platelet count.
What is the purpose of antigen typing and zygosity testing?
Perform antigen typing and zygosity testing on the father of the baby to determine if platelet antigen incompatibility between the parents exists and if all potential offspring will be at risk for NAIT. If the father is a heterozygote, each subsequent fetus has only a 50% chance of being affected.
Can IgG antibodies be transmitted through breast milk?
IgG antiplatelet antibodies are transmitted through the breast milk, so consider monitoring the platelet count s in breastfed newborns of mother s with ITP. The major neonatal concern in ITP is the risk of fetal or newborn intracranial or visceral hemorrhage due to severe thrombocytopenia.
Is there a need for additional blood tests during pregnancy?
The patient should be educated about the need for additional blood tests and followup during pregnancy and the potential need to consider treatment for ITP , which is the case in one-third of pregnant women with ITP. The small risk of maternal and fetal complications should be discussed.
Does thrombocytopenia correlate with maternal platelet count?
Newborn thrombocytopenia is difficult to predict because newborn platelet counts do not always correlate with maternal platelet counts or antiplatelet antibody titers. [ 7, 18] The newborn platelet count does correlate with the platelet count of previous first and second siblings at birth.
What is ITP in pregnancy?
ITP is an autoimmune condition where a woman’s immune system attacks and destroys her own platelets. Women diagnosed with ITP before pregnancy are managed similarly until the end of the third trimester, typically with glucocorticoids (steroids) as necessary, and avoiding splenectomy, if possible.
What is thrombocytopenia in pregnancy?
What is Thrombocytopenia? Thrombocytopenia is a deficiency of platelets in the blood, defined when the platelet count is less than 150,000. This deficiency occurs in approximately 5 percent of normal pregnancies. Thrombocytopenia may lead to increased bleeding, bruising, or abnormal blood clotting.
What causes thrombocytopenia in the lab?
The most common causes of thrombocytopenia are lab error (due to platelets clumping in the counter machine), gesta tional thrombocytopenia, preeclampsia, and autoimmune thrombocytopenia, including idiopathic thrombocytopenic purpura (ITP).
What is the risk of fetal thrombocytopenia?
The Risk of Fetal Thrombocytopenia. With ITP, there is a 5 to 10 percent risk of fetal thrombocytopenia. This can lead to abnormal bleeding in the newborn, and sometimes even prior to birth.
Does ITP increase with lower platelet count?
However, as the platelet count lowers, the chance of ITP increases. If the platelet count is below 50,000, ITP is very likely. It is important to distinguish gestational thrombocytopenia from ITP because only ITP is associated with fetal thrombocytopenia.
Can gestational thrombocytopenia be caused by ITP?
The exact cause of gestational thrombocytopenia is unknown, but it may take form from a milder and short-term ITP, as many of the characteristics overlap, aside from the severity of thrombocytopenia, and risk of fetal thrombocytopenia.
Is gestational thrombocytopenia asymptomatic?
Gestational Thrombocytopenia. Women with gestational thrombocytopenia are shown to have a mild, asymptomatic thrombocytopenia, no history of this condition (except during a past pregnancy), occurring late in pregnancy, no association with fetal thrombocytopenia, and spontaneously resolves during or after pregnancy.
How to treat ITP?
Medications to treat ITP may include: 1 Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. Long-term use of these medications isn't recommended because they can increase your risk of infections, high blood sugar and osteoporosis. 2 Immune globulin. If corticosteroids don't help, your doctor may give you an injection of immune globulin. This drug may also be used if you have critical bleeding or need to quickly increase your blood count before surgery. The effect usually wears off in a couple of weeks. 3 Drugs that boost platelet production. Medications such as romiplostim (Nplate) and eltrombopag (Promacta) help your bone marrow produce more platelets. These types of drugs can increase your risk of blood clots. 4 Other drugs. Rituximab (Rituxan, Truxima) helps increase your platelet count by reducing the immune system response that's damaging your platelets. But this drug also can reduce the effectiveness of vaccinations, which may be needed if you later choose surgery to remove your spleen.
What is the best treatment for ITP?
Medications to treat ITP may include: Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor.
What are some medications that can help with platelet function?
Examples include aspirin, ibuprofen (Advil, Motrin IB, others) and ginkgo biloba. Medications to treat ITP may include: Steroids.
What is the diagnosis of immune thrombocytopenia?
To diagnose immune thrombocytopenia, your doctor will try to exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you or your child may be taking.
What to do if you have thrombocytopenia?
If you have immune thrombocytopenia, try to: Avoid contact sports. Depending on your risk of bleeding, head impacts during sports like boxing, martial arts and football could cause bleeding in your brain. Talk to your doctor about what activities are safe for you. Watch for signs of infection.
Can ITP cause bleeding?
Although rare, severe bleeding can occur with ITP. Emergency care usually includes transfusions of platelet concentrates. Steroids and immune globulin may also be given through a tube in a vein.
Can low platelet count cause thrombocytopenia?
Preparing for your appointment. Because a low platelet count may not cause symptoms, the problem is often discovered when you have a blood test for another reason. To diagnose immune thrombocytopenia, your doctor is likely to order further blood tests that require drawing a small amount of blood from a vein in an arm.
How many ITP neonates have thrombocytopenia?
Approximately 4% of ITP neonates are born with severe thrombocytopenia (platelet counts < 20 000 × 10 9 /L), but importantly few have platelet counts that are less than 5000 × 10 9 /L unless alloantibodies are also present. 87 The severity of neonatal thrombocytopenia is often most marked 1 to 3 days after birth.
What is the goal of ITP therapy?
(1) The goal of therapy in this population is to maintain a hemostatic platelet count while minimizing drug-induced toxicity; select patients may require somewhat higher platelet counts because of comorbid risk factors as discussed in “Treatment of chronic ITP.”.
Can ITP be considered for pregnancy?
Women with ITP may consult their physician as to the safety of becoming pregnant or the diagnosis may be considered for the first time during pregnancy because years may have passed since a complete blood count was performed. Several comprehensive reviews have been published. 2, 75