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Haematologica. 2014 Aug;99(8):1387-94. doi: 10.3324/haematol.2014.105924. Epub 2014 Apr 24.

Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia.

Author information

1
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy.
2
National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France.
3
Service of Biometry and Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
4
Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina.
5
Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica Sant Pau, Spain.
6
Department of Medicine-DIMED, University of Padova Medical School, Italy.
7
AP-HP, Armand Trousseau Children's Hospital, Haematological Laboratory, French Reference Center for Inherited Platelet disorders, Paris, France Inserm UMR1009, Villejuif, France.
8
Department of Internal Medicine, University of Perugia, Italy.
9
Centre de Compétence Nord-Est des Pathologies Plaquettaires from the frame of the Reference French Centre, France Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France.
10
Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
11
Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
12
Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany.
13
Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
14
Servizio Malattie Emorragiche e Trombotiche, Istituto di Medicina Interna e Geriatria, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.
15
Immunohematology Department, Banc de Sang i Teixits de Catalunya, Barcelona, Spain.
16
Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU, Lille, France.
17
Département des Spécialités de Médecine, Service d'Hématologie, Hôpitaux Universitaires de Genève, Suisse Université de Genève, Faculté de Médecine, Suisse.
18
Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi, University of Bologna, Italy.
19
Department of Medical Sciences, University of Trieste, Italy Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
20
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy c.balduini@smatteo.pv.it.
21
Service d'Hémostase Bio-Clinique, Centre Régional de traitement des maladies hémorragiques de Rennes-Bretagne, CHU de Rennes, Rennes, France.
22
Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU Lille, France.
23
Université Mohamed V Rabat, Faculté de Médecine et de Pharmacie, Hôpital Avicenne, Rabat, Morocco.
24
Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
25
CHU Charles Nicolle, Unité Hémostase-Hématologie, Rouen, France.
26
Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
27
Weill Medical College of Cornell University, New York, NY, USA.
28
Department of Medical Sciences, University of Trieste, Trieste, Italy.
29
Service d'hématologie Biologie, Centre Hospitalo-Universitaire Dijon, France.
30
Department of Internal Medicine, University of Perugia, Perugia, Italy.
31
Department of Medicine-DIMED; University of Padova Medical School, Padova, Italy.
32
Unité d'Hémato-Oncologie pédiatrique, Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgique.
33
Service de Néphrologie, CH Valenciennes, Valenciennes, France.
34
Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU Haut Lévêque, Pessac, France.
35
INSERM UMR-S949/EFS-Alsace, Strasbourg, France.
36
Department of Oncology, Azienda Santobono-Pausilipon, Pausilipon Hospital, Napoli, Italy.
37
Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy.
38
Laboratoire de Génétique, CH Le Mans, France.
39
Centre Hospitalier de la côte basque, Bayonne, France.
40
Service de Génétique Clinique, Centre de Référence Anomalies du Développement du Grand Ouest, CHU Rennes-Hôpital Sud, Rennes, France.
41
Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy.
42
Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy.
43
Department of Pediatrics, University of Brescia, Brescia, Italy.
44
Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU La Timone, Marseille, France.
45
AP-HP, Armand Trousseau children Hospital, Department of Anesthesiology, Paris, France.
46
Hématologie clinique et thérapie cellulaire, CHU Amiens, France.
47
Laboratoire d'Hématologie and National Reference Centre of Inherited Platelet Disorders, CHU Rangueil, Toulouse, France.
48
Service d' Hématologie Biologique, CHU Hôpital Européen Georges Pompidou, Paris, France.
49
Service de Biologie Clinique Secteur Hématologie, CH Victor Dupouy, Argenteuil, France.
50
Hematology Unit, Spedali Civili Hospital and University of Brescia, Brescia, Italy.

Abstract

Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L.

PMID:
24763399
PMCID:
PMC4116839
DOI:
10.3324/haematol.2014.105924
[Indexed for MEDLINE]
Free PMC Article

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