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Management of immunological thrombocytopenia during pregnancy Volume 18, issue 4, Avril 2006

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Service d’Hématologie biologique, hôpital Antoine Béclère, 92141 Clamart

Thrombocytopenia is common in pregnancy, its incidence being increased by systematic platelet counts during pregnancy. About 10 % of pregnant women demonstrate thrombocytopenia before delivery, mostly asymptomatic, without any pathology, nor signs of severity for mother with newborn. It is important to determine which type of thrombocytopenia has to be treated, requiring recurate diagnosis. In 70 % of cases, thrombocytopenia is gestational and the differential diagnosis with immune thrombocytyopenic purpura (ITP) (1 to 5 cases per 1000 deliveries) is not easy. The severity of thrombocytopenia is a pertinent argument for ITP (platelets below 50 g/l), but also low platelets count prior to pregnancy, previous affected child, splenectomy for ITP. Diagnosis could be paradoxically easier in specific clinical situations, such as connective tissue diseases, antiphospholipid syndrome, hepatitis, HIV disease, leading to appropriate treatment. Severe obstetrical related diseases, including disseminated intravascular coagulation, thrombotic microangiopathies, such as preeclampsia, HELLP syndrome, or the rare thrombotic thrombocytopenic purpura, are usually treated as emergencies. Treatment of maternal ITP depends on the degree of thrombocytopenia, and is only required for delivery. Intravenous immunoglobulins remain the reference treatment in this indication. Neonatal thrombocytopenia, due to maternal antibodies crossing the placenta, is treated by immunoglobulins and corticosteroids, if platelets are below 20 g/l and/or in cases of bleeding.