Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura
Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura
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DOI：
10.1002/ajh.22178
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发表时间：
2012-01-01
影响因子：
12.8
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
--
作者：
Koyama, Shinsuke;Tomimatsu, Takuji;Kimura, Tadashi
在患有特发性血小板减少性紫癜（ITP）的妇女所生的婴儿中，约1015%患有短暂性新生儿免疫性血小板减少性紫癜（NITP）。值得关注的是缺乏一个可靠的预测NITP。我们对大坂大学医院过去16年中所有ITP孕妇进行了回顾性研究，分析了88名ITP孕妇的127例妊娠，以评估各种临床因素对当前妊娠新生儿血小板计数的预测价值。我们还回顾了有关妊娠期ITP和NITP预测的文献。130例新生儿中有20例（15.4%）新生儿血小板计数低于100 x 109/L，11例（8.5%）新生儿血小板计数低于50 x 109/L，3例（2.3%）新生儿血小板计数低于20 x 109/L。第一和第二兄弟姐妹之间关于NITP的发生和严重程度的强相关性，出生时的斯皮尔曼相关系数为0.55（P = 0.001），出生后的最低值为0.63（P < 0.0001）。分娩时母体血小板计数低于100 × 109/L显示与NITP发生相关的统计学趋势（P = 0.043）。此外，根据文献综述，脾切除术难治性的母体ITP与胎儿或新生儿ICH的风险较高相关。总之，孕妇谁有一个以前的后代与NITP或谁有ITP难治性脾切除术可能是在特定的风险交付的后代与显着的NITP。管理决策，包括交付方式，可能会改变潜在的严重NITP的风险程度。Am.血液学杂志，2012. (C)2011 Wiley Periodicals，Inc.
Of infants born to women with idiopathic thrombocytopenic purpura (ITP), about 1015% have transient neonatal immune thrombocytopenic purpura (NITP). Of concern is the lack of a reliable predictor for NITP. We conducted a retrospective study of all pregnancies with ITP at Osaka University Hospital over the past 16 years analyzing a total of 127 pregnancies in 88 women with ITP to assess the predictive value of various clinical factors regarding neonatal platelet count in the current pregnancy. We also reviewed the literature concerning ITP in pregnancy and NITP prediction. Neonatal platelet counts were less than 100 x 109/L in 20 of 130 neonates (15.4%), less than 50 x 109/L in 11 neonates (8.5%), and less than 20 x 109/L in three neonates (2.3%). There was a strong correlation between the first and second sibling regarding the occurrence and the severity of NITP with Spearman correlation coefficient of 0.55 (P = 0.001) at birth and 0.63 (P < 0.0001) at nadir after birth. A maternal platelet count less than 100 x 109/L at delivery showed a statistical trend for an association with the occurrence of NITP (P = 0.043). Moreover, maternal ITP refractory to splenectomy correlated with a higher risk for fetal or neonatal ICH according to the review of the literature. In conclusion, pregnant women who have had a previous offspring with NITP or who have ITP refractory to splenectomy may be at particular risk of delivering an offspring with significant NITP. Management decisions, including mode of delivery, may be altered by the degree of risk for potentially severe NITP. Am. J. Hematol., 2012. (C) 2011 Wiley Periodicals, Inc.