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An Overview of Hematology Consultations Due to Thrombocytopenia During Pregnancy: A Single Center Experience

Year 2020, Volume: 17 Issue: 1, 122 - 126, 29.04.2020
https://doi.org/10.35440/hutfd.642775

Abstract

Background: Thrombocytopenia in pregnant women is perhaps the most worrisome among hematologic complications for obstetricians. There are no studies on hematological diseases seen in pregnant women in our province whose birth and maternal mortality rates are above the country average. Therefore, in this study, we aimed to evaluate the general characteristics of thrombocytopenic pregnant women consulted by gynecologists in our province, to determine the etiology and incidence of thrombocytopenic pregnancies and to raise awareness on this issue.
Materials and Methods: The study included 122 pregnant women aged 18-44 years who had thrombocytopenia on routine hemograms and were referred to the only hematology outpatient clinic in the province. The following parameters of the patients were evaluated; maternal age, gestational age, platelet count on admission, presence of hemorrhage, peripheral smear diagnoses, treatments and need for second line therapy.
Results: Mean age of the patients was 26.0 ± 4.8, gestational age was 27.4 ± 8.1 and mean platelet count was 79.000 ± 52.300 / microL. 65 patients (53.3%) had gestational thrombocytopenia, 27 patients (22.1%) idiopathic thrombocytopenic purpura, 13 patients (10.7%) pseudothrombocytopenia, 4 (3.3%) patients HELLP (hemolysis, increased liver enzymes, low platelet count) Acute leukemia was diagnosed in 4 (3.3%) patients, Bernard Soulier Syndrome in 4 (3.3%), disseminated intravascular coagulation and megaloblastic anemia in 2 patients (1.6%) and Evans syndrome in 1 patient. The gestational age and platelet counts of 19 pregnant women with consultation and 103 women without bleeding were significantly different (p <0.001).
Conclusion: Although most of the thrombocytopenia encountered in pregnant women in our province is due to obstetrics, there may be rare hematologic diseases in pregnant women with severe thrombocytopenia in the early period. For this reason, it is important to consult the hematology outpatient clinic in order to increase the chances of survival of the pregnant women presenting in the early period and having severe thrombocytopenia.

References

  • KAYNAKLAR1. Özsürmeli, M., Sucu, M., Çetin, C., Khatib, G., Demir, C. Gebelikte Trombositopeni. Arşiv Kaynak Tarama Dergisi. 2016; 25(3), 420-432.
  • 2. McCrae KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Rev 2003; 17: 7–14.
  • 3. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993; 329:1463-6
  • 4. Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol. 2012; 158:3-15
  • 5. Pafumi, C., Valenti, O., Giuffrida, L., Colletta, G., D’agati, A., Leanza, V., et al. Gestational thrombocytopenia: does it cause any maternal and/or perinatal morbidity. Cukurova Med J. 2013; 38(3), 349-57.
  • 6. Sreedharan PS, Rakesh S, Sanjeev S, Pavithran, K., Thomas, M. Case report Subdural haematoma with spontaneous resolution-Rare manifestation of idiopathic thrombocytopenic purpura. JAPI. 2000; 48:432-4.
  • 7. Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010;85(3):174.
  • 8. Parnas M, Sheiner E, Shoham-Vardi I, Burstein, E., Yermiahu, T., Levi, I. Moderate to severe thrombocytopenia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):163-8. Epub 2006 Mar 13.
  • 9. Zafar, S., Sultana, S., Iqbal, W., Bhatti, F. A., Khanam Akhtar, K. A., Muhammed, A et al. Pregnancy Outcome in Bernard‐Soulier Syndrome Complicated by Preeclampsia. J Turk Ger Gynecol Assoc.2007; 8, 324-6.
  • 10. Peitsidis, P., Datta, T., Pafilis, I., Otomewo, O., Tuddenham, E. G. D., Kadir, R. A. Bernard Soulier syndrome in pregnancy: a systematic review. Haemophilia. 2010; 16(4), 584-591.
  • 11. Yüce, t., Seval, M. M., Acar, D., Atabekoğlu, C. Thrombocytopenia in Pregnancy: Evans Syndrome, an Unconventional Diagnosis Evans Syndrome in Pregnancy: Case Report. Turkiye Klinikleri J Int Med Sci. 2008; 4, 1.
  • 12. Akpak, Y., Kaya, N., Gün, İ., Atay, V. Gebelikte Trombositopeni; Akut Lösemi Olabilir mi? Ankara Medical Journal.2014; 13(2).
  • 13. Küçük, M., Yavaşoğlu, İ., Kadıköylü, G., Bolaman, Z. Gebelik ve Hematoloji. RISK. 2011; 66, 71.

Gebelikte Trombositopeni Sebebi ile İstenen Hematoloji Konsültasyonlarına Genel Bakış: Tek Merkez Deneyimi

Year 2020, Volume: 17 Issue: 1, 122 - 126, 29.04.2020
https://doi.org/10.35440/hutfd.642775

Abstract

Amaç: Gebelerdeki trombositopeni kadın doğum uzmanları için hematolojik komplikasyonlar arasında belki de en tedirgin edicisidir. Doğum ve anne ölüm oranları ülke ortalamasının üzerinde olan ilimizdeki gebelerde görülen hematolojik hastalıklarla ilgili yapılmış çalışma yoktur. Bu yüzden çalışmamızda ilimizdeki kadın doğum uzmanlarının hematolojiye konsülte ettikleri trombositopenik gebelerin genel özelliklerini değerlendirmek, etyolojilerini ve insidansını belirlemek ve bu konudaki farkındalığı arttırmayı amaçladık.
Materyal ve Metod: Çalışmaya 18-44 yaş arası rutin hemogramlarında trombositopeni saptanan ve ildeki tek hematoloji polikliniğine konsülte edilen 122 gebe dahil edildi. Hastaların şu parametreleri değerlendirildi; anne yaşı, gebelik haftası, başvurudaki trombosit sayısı, kanama olup olmaması, periferik yayma sonucu konulan tanılar, uygulanan tedaviler ve ikinci basamak tedavi ihtiyacı.
Bulgular: Hastaların ortalama yaşları 26.0±4.8, gebelik haftaları 27.4±8.1, ortalama trombosit sayıları ise 79.000±52.300/mikroL idi. 65 hastaya (%53.3) gestasyonel trombositopeni, 27 hastaya (%22.1) idiyopatik trombositopenik purpura, 13 hastaya (%10.7) psödotrombositopeni, 4 (%3.3) hastaya HELLP (hemoliz, artmış karaciğer enzimleri, düşük trombosit sayısı), 4 (%3.3) hastaya akut lösemi, 4 (%3.3) hastaya Bernard Soulier Sendromu, 2’şer hastaya (%1.6) dissemine intravasküler koagülopati ve megaloblastik anemi ve 1 hastaya Evans Sendromu tanısı konuldu. Konsülte edildiğinde kanaması olan 19 gebe ve kanaması olmayan 103 kadının gebelik haftaları ve trombosit sayıları ise anlamlı şekilde farklıydı (p<0.001).
Sonuç: İlimizdeki gebelerde karşılaşılan trombositopenilerin çoğu obstetrilk kaynaklı olsada, erken dönemde ciddi trombositopeni ile seyreden gebelerde hematoloji kökenli nadir hastalıklar da olabilir. Bu sebeple ilimizde erken dönemde başvuran ve ciddi trombositopenisi olan gebelerin yaşam şansını arttırmak ve tanılarının erken ve doğru bir şekilde koyulabilmesi için hızlıca hematoloji polikliniğine konsülte edilmeleri önemlidir.

References

  • KAYNAKLAR1. Özsürmeli, M., Sucu, M., Çetin, C., Khatib, G., Demir, C. Gebelikte Trombositopeni. Arşiv Kaynak Tarama Dergisi. 2016; 25(3), 420-432.
  • 2. McCrae KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Rev 2003; 17: 7–14.
  • 3. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993; 329:1463-6
  • 4. Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol. 2012; 158:3-15
  • 5. Pafumi, C., Valenti, O., Giuffrida, L., Colletta, G., D’agati, A., Leanza, V., et al. Gestational thrombocytopenia: does it cause any maternal and/or perinatal morbidity. Cukurova Med J. 2013; 38(3), 349-57.
  • 6. Sreedharan PS, Rakesh S, Sanjeev S, Pavithran, K., Thomas, M. Case report Subdural haematoma with spontaneous resolution-Rare manifestation of idiopathic thrombocytopenic purpura. JAPI. 2000; 48:432-4.
  • 7. Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports. Am J Hematol. 2010;85(3):174.
  • 8. Parnas M, Sheiner E, Shoham-Vardi I, Burstein, E., Yermiahu, T., Levi, I. Moderate to severe thrombocytopenia during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):163-8. Epub 2006 Mar 13.
  • 9. Zafar, S., Sultana, S., Iqbal, W., Bhatti, F. A., Khanam Akhtar, K. A., Muhammed, A et al. Pregnancy Outcome in Bernard‐Soulier Syndrome Complicated by Preeclampsia. J Turk Ger Gynecol Assoc.2007; 8, 324-6.
  • 10. Peitsidis, P., Datta, T., Pafilis, I., Otomewo, O., Tuddenham, E. G. D., Kadir, R. A. Bernard Soulier syndrome in pregnancy: a systematic review. Haemophilia. 2010; 16(4), 584-591.
  • 11. Yüce, t., Seval, M. M., Acar, D., Atabekoğlu, C. Thrombocytopenia in Pregnancy: Evans Syndrome, an Unconventional Diagnosis Evans Syndrome in Pregnancy: Case Report. Turkiye Klinikleri J Int Med Sci. 2008; 4, 1.
  • 12. Akpak, Y., Kaya, N., Gün, İ., Atay, V. Gebelikte Trombositopeni; Akut Lösemi Olabilir mi? Ankara Medical Journal.2014; 13(2).
  • 13. Küçük, M., Yavaşoğlu, İ., Kadıköylü, G., Bolaman, Z. Gebelik ve Hematoloji. RISK. 2011; 66, 71.
There are 13 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Nefise Nazlı Yenigül 0000-0003-3365-8899

Ahmet Kürşat Güneş 0000-0001-5522-8342

Dilek Buldum This is me 0000-0001-6328-1055

Publication Date April 29, 2020
Submission Date November 5, 2019
Acceptance Date April 21, 2020
Published in Issue Year 2020 Volume: 17 Issue: 1

Cite

Vancouver Yenigül NN, Güneş AK, Buldum D. Gebelikte Trombositopeni Sebebi ile İstenen Hematoloji Konsültasyonlarına Genel Bakış: Tek Merkez Deneyimi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(1):122-6.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty