Borhany Munira, Abid Madiha, Zafar Sidra, Zaidi Uzma, Munzir Saima, Shamsi Tahir
Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK.
Research and Development, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK.
Cureus. 2022 Mar 25;14(3):e23490. doi: 10.7759/cureus.23490. eCollection 2022 Mar.
The study aimed to evaluate the causes of thrombocytopenia in pregnancy and its management along with the outcome in the COVID-19 era.
Recruitment for this prospective, cross-sectional observational study of thrombocytopenia in pregnancy (platelet counts <100x10/L) was done from January 2017 to August 2020 at the National Institute of Blood Diseases (NIBD) after taking the patients' informed consent. Complete clinical and lab profile of patients was also collected.
A total of 150 pregnant women with thrombocytopenia were enrolled, with the mean age being 27.3±4.64 years. Mean platelet counts at baseline were 48.0±24. Main clinical manifestations at baseline included: anemia 65.9%, bruises 23.25%, and edema 9.3%. Causes of thrombocytopenia were gestational thrombocytopenia (GT) 72 (48%), acute fatty liver five (3.3%), pre-eclampsia in 11 (7.3%), and eclampsia seven (4.6%). Causes not specific to pregnancy included 30 (20%) cases of ITP, hepatitis C, and nutritional deficiency was reported in nine (6%) patients each. 72/150 received supportive care treatment to manage thrombocytopenia and were closely monitored and given supplements. Twenty (66.6%) ITP patients received treatment with steroids, with complete response in 70% of them seen. Overall, 38 (25.3%) women with bleeding symptoms and platelet count <50x10/L received platelet transfusions.
The study shows that pre-eclampsia and eclampsia are serious conditions with a high risk for complications, while GT is a benign and the most common cause of thrombocytopenia in pregnancy which requires no active treatment. The other causes such as ITP and infections require individualized management.
本研究旨在评估新冠疫情时代妊娠期血小板减少症的病因、治疗及其结局。
2017年1月至2020年8月期间，在获得患者知情同意后，于国家血液疾病研究所对妊娠期血小板减少症（血小板计数<100×10⁹/L）进行了这项前瞻性横断面观察性研究。同时收集了患者完整的临床和实验室资料。
共纳入150例妊娠期血小板减少症孕妇，平均年龄为27.3±4.64岁。基线时平均血小板计数为48.0±24。基线时的主要临床表现包括：贫血65.9%、瘀斑23.25%、水肿9.3%。血小板减少症的病因包括：妊娠期血小板减少症（GT）72例（48%）、急性脂肪肝5例（3.3%）、先兆子痫11例（7.3%）、子痫7例（4.6%）。非妊娠特异性病因包括30例（20%）免疫性血小板减少性紫癜（ITP），丙型肝炎以及营养缺乏各有9例（6%）患者。72/150例患者接受了支持性治疗以管理血小板减少症，并接受密切监测和补充剂。20例（66.6%）ITP患者接受了类固醇治疗，其中70%出现完全缓解。总体而言，38例（25.3%）有出血症状且血小板计数<50×10⁹/L的女性接受了血小板输注。
该研究表明，先兆子痫和子痫是严重疾病，并发症风险高，而GT是妊娠期血小板减少症的良性且最常见病因，无需积极治疗。其他病因如ITP和感染则需要个体化管理。
