Koyama T, Suehiro A, Kakishita E, Taira S, Isojima S, Norioka M, Ito K
Second Department of Internal Medicine, Hyogo College of Medicine, Kyoto University Hospital, Japan.
Am J Hematol. 1990 Nov;35(3):179-83. doi: 10.1002/ajh.2830350307.
We have investigated the methods for the maintenance of a pregnancy in a patient with thrombotic thrombocytopenic purpura (TTP), said condition, since 1984, having been controlled by a plasma infusion every 3 to 4 weeks. In a preliminary trial it was confirmed that an infusion of the high molecular weight fraction (HMW-F) of plasma, separated by an Evaflux 2A fractionator, improved the patient's thrombocytopenia as the plasma infusion, and maintained its beneficial effect for about 2 weeks during early pregnancy. Though an occurrence of a toxemia-like syndrome responded to repeated plasma infusion, the dose of plasma required to improve the thrombocytopenia gradually increased and reached 5,040 ml by the 20th week of pregnancy. Thus, instead of periodic infusions of whole plasma, periodic infusions of the HMW-F of plasma were used. Under this regimen the platelet count remained above 10.0 x 10(4)/microliters during late pregnancy, and the total dose (2,600 ml) of HMW-F of plasma that was administered until delivery at full term was less than the dosage of whole plasma that was used during early pregnancy. In this manner we were able to obtain a healthy baby by controlling the patient's TTP during pregnancy. This method of preventing thrombocytopenia appears to be safer with respect to volume loading during pregnancy in the TTP patient.
我们研究了维持血栓性血小板减少性紫癜（TTP）患者妊娠的方法。自1984年以来，该疾病通过每3至4周进行一次血浆输注得以控制。在一项初步试验中证实，通过Evaflux 2A分级分离器分离的血浆高分子量组分（HMW-F）输注，如同血浆输注一样可改善患者的血小板减少症，并在妊娠早期维持约2周的有益效果。尽管类似毒血症综合征的发作对重复血浆输注有反应，但改善血小板减少症所需的血浆剂量逐渐增加，至妊娠第20周时达到5040毫升。因此，采用了定期输注血浆HMW-F而非全血浆的方法。在该方案下，妊娠晚期血小板计数维持在10.0×10⁴/微升以上，直至足月分娩时所输注的血浆HMW-F总量（2600毫升）少于妊娠早期使用的全血浆剂量。通过这种方式，我们在孕期控制患者的TTP，成功产下了一个健康的婴儿。对于TTP患者，这种预防血小板减少症的方法在妊娠期间的容量负荷方面似乎更安全。
