Subscribe to RSS
DOI: 10.1055/s-0033-1358129
Erstdiagnose einer Autoimmunthrombozytopenie in der Schwangerschaft mit schwerem Verlauf[*]
Severe Case of Autoimmune Thrombocytopenia First Diagnosed in PregnancyPublication History
eingereicht 17 July 2013
revidiert 02 November 2013
akzeptiert 05 November 2013
Publication Date:
26 May 2015 (online)
![](https://www.thieme-connect.de/media/transfusionsmedizin/201502/lookinside/thumbnails/10-1055-s-0033-1358129_tf075-1.jpg)
Zusammenfassung
Wir berichten von einer 28-jährigen Erstgravida, die sich im 2. Trimenon mit plötzlich aufgetretener Blutungsneigung und Thrombozytopenie von 2/nl bei der Erstmanifestation einer ITP vorstellte. Die initiierte Therapie mit intravenösen Immunglobulinen (IVIG) und Steroiden konnte erneute Blutungsereignisse und rezidivierende Thrombozytopenien langfristig nicht verhindern, sodass eine vorzeitige Entbindung per Sectio nach Applikation der Lungenreifeinduktion in 32 + 3 SSW nicht vermeidbar war. Die Blutungskomplikationen konnten nur durch multiple Thrombozytentransfusionen beherrscht werden. Aufgrund postpartaler Therapierefraktärität der ITP wurde ein Thrombopoetin-Rezeptoragonist (TPO-RA) appliziert, der zum Anstieg der Thrombozytenzahl führte, die später mithilfe von Prednisolon allein stabilisiert werden konnte.
Abstract
We report on a 28-year old primigravida who presented in the second trimester with sudden onset of bleeding tendencies and thrombocytopenia of 2/nL during the first manifestation of autoimmune thrombocytopenia (ITP). Therapy with intravenous immunoglobulins (IVIG) and steroids was initiated but could not prevent renewed bleeding incidents and recurrent thrombocytopenia in the long term, thus premature delivery by Caesarean section in the 32 + 3 week of pregnancy could not be avoided. The bleeding complications could only be mastered by multiple thrombocyte transfusions. Because the ITP remained refractory to therapy in the postpartum period a thrombopoietin receptor agonist (TPO-RA) was administered. This led to an increase in the thrombocyte count which was later stabilised by prednisolone alone.
Schlüsselwörter
Schwangerschaft - ITP - Autoimmunthrombozytopenie - Geburtshilfe - Frühgeburt - KoagulopathieKey words
pregnancy - ITP - autoimmune thrombocytopenia - obstetrics - premature birth - coagulopathy* Erstveröffentlichung in: Geburtsh Frauenheilk 2013; 73: 1252–1255
-
Literatur
- 1 Sullivan CA, Martin jr. JN. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol 1995; 38: 521-534
- 2 Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood 2013; 121: 38-47
- 3 Gernsheimer T. Thrombocytopenia in pregancy: is this immune thrombocytopenia or …?. Hematology Am Soc Hematol Educ Program 2012; 198-202
- 4 Webert K, Mittal R, Sigouin C et al. A retrospective 11-year-analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102: 4306-4311
- 5 Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am 2009; 23: 1299-1316
- 6 Crowther MA, Burrows RF, Ginsberg J et al. Review thrombocytopenia in pregnancy: diagnosis, pathogenesis and management. Blood Rev 1996; 10: 8-16
- 7 Kwon JY, Shin JC, Lee JW et al. Predictors of idiopathic thrombocytopenic purpura in pregnant women presenting with thrombocytopenia. Int J Gynaecol Obstet 2007; 96: 85-88
- 8 McMillan R, Wang L, Tomer A et al. Suppression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood 2004; 103: 1364-1369
- 9 Neunert C, Lim W, Crowther M et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117: 4190-4207
- 10 Provan D, Stasi R, Newland AC et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115: 168-186
- 11 Negi VS, Elluru S, Sibéril S et al. Intravenous immunoglobulin: an update on the clinical use and mechanisms of action. J Clin Immunol 2007; 27: 233-245
- 12 Alkaabi JK, Alkindi S, Riyami NA et al. Successful treatment of severe thrombocytopenia with romiplostim in a pregnant patient with systemic lupus erythematosus. Lupus 2012; 21: 1571-1574
- 13 British Committee for Standards in Haematology. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120: 574-596
- 14 Koyama S, Tomimatsu T, Kanagawa T et al. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol 2012; 87: 15-21
- 15 Burrows RF, Kelton JG. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery. Obstet Gynecol Surv 1993; 49: 781-788
- 16 Palmeira P, Quinello C, Silveira-Lessa AL et al. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol 2012; 2012: 985646
- 17 Salama A. Current treatment options for primary immune thrombocytopenia. Expert Rev Hematol 2011; 4: 107-118