ITP in Pregnancy

See also ITP main page

Background

  • Marked diff between maternal and fetal platelet counts
  • No antenatal measures predict fetal status
  • Maternal response to medicine does not guarantee a favorable outcome for baby
  • Only previous neonatal outcomes provide predictor of neonatal platelet counts.

Clinical Features

Differential Diagnosis

Thrombocytopenia

Decreased production

Increased platelet destruction or use

Drug Induced

Comparison by Etiology

ITP TTP HUS HIT DIC
↓ PLT Yes Yes Yes Yes Yes
↑PT/INR No No No +/- Yes
MAHA No Yes Yes No Yes
↓ Fibrinogen No No No No Yes
Ok to give PLT Yes No No No Yes

Evaluation

  • Usually mild thrombocytopenia (>70k)
    • Platelet count normalizes after delivery

Management

  • Balance risk of thrombocytopenia (for mother and fetus/baby) vs potential teratogenesis from therapy
  • Treatment indicated if[1]:
    • Platelets <10,000
    • Platelets <30,000 and bleeding or in 2nd or 3rd trimester
  • Risk of prednisone or IVIG outweighed by benefits in above situations[2]
  • Infant has slightly increased risk of ICH with v low risk of ICH- but higher of normal baby
    • role of cesarean in preventing ICH controversial
  • If baby has platelets <30k; IVIG and or prednisone
  • No contraindication to breastfeeding.

See Also

References

  1. Stavrou E, Mccrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2009;23(6):1299-316.
  2. https://www.ouh.nhs.uk/patient-guide/leaflets/files/13880Pitp.pdf