Department of Pathology and Laboratory Medicine.
Department of Medicine, and.
Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):144-151. doi: 10.1182/asheducation-2017.1.144.
Thrombocytopenia develops in 5% to 10% of women during pregnancy or in the immediate postpartum period. A low platelet count is often an incidental feature, but it might also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances made over the past 5 to 10 years in understanding and managing the more common causes of thrombocytopenia in pregnancy. Recent trends in the management of immune thrombocytopenia translate into more women contemplating pregnancy while on treatment with thrombopoietin receptor agonists, rituximab, or mycophenylate, which pose known or unknown risks to the fetus. New criteria to diagnose preeclampsia, judicious reliance on measurement of ADAMTS13 to make management decisions in suspected thrombotic thrombocytopenic purpura, new evidence supporting the efficacy and safety of anticomplement therapy for atypical hemolytic uremic syndrome during pregnancy, and implications of thrombotic microangiopathies for subsequent pregnancies are evolving rapidly. The goals of the chapter are to help the hematology consultant work through the differential diagnosis of thrombocytopenia in pregnancy based on trimester of presentation, severity of thrombocytopenia, and coincident clinical and laboratory manifestations, and to provide guidance for dealing with some of the more common and difficult diagnostic and management decisions.
妊娠或产后即刻，5%至 10%的女性会发生血小板减少症。血小板计数低通常是偶然发现的特征，但它也可能是同时存在的系统性或妊娠疾病的生物标志物，以及可能对胎儿造成伤害的母体干预或治疗的潜在原因。本章反映了我们处理这些问题的方法，重点是过去 5 至 10 年来在理解和治疗妊娠中更常见的血小板减少症的病因方面取得的进展。免疫性血小板减少症治疗管理方面的最新趋势意味着更多的女性在接受血小板生成素受体激动剂、利妥昔单抗或吗替麦考酚酯治疗时考虑怀孕，而这些药物对胎儿存在已知或未知的风险。新的子痫前期诊断标准、在疑似血栓性血小板减少性紫癜时明智地依赖 ADAMTS13 测量来做出管理决策、新的证据支持妊娠期间抗补体治疗非典型溶血尿毒综合征的疗效和安全性、以及血栓性微血管病对随后妊娠的影响，这些都在迅速发展。本章的目标是帮助血液学顾问根据发病的妊娠阶段、血小板减少症的严重程度以及同时出现的临床和实验室表现，对妊娠中的血小板减少症进行鉴别诊断，并为处理一些更常见和更困难的诊断和管理决策提供指导。
