Anteby E, Shalev O
Department of Obstetrics and Gynecology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel.
Am J Hematol. 1994 Oct;47(2):118-22. doi: 10.1002/ajh.2830470210.
We identified 22 women with thrombocytopenia of < 100,000/microliters found incidentally during pregnancy and prospectively monitored their platelet count and clinical outcome for a minimum of 6 months postpartum. During the study period, four women became pregnant twice, accounting for a total of 26 pregnancies. The lowest platelet count during pregnancy was 65,600/microliters +/- 19,400 (mean +/- SD), and at delivery 84,500/microliters +/- 32,300 (P < 0.02). The thrombocytopenia was virtually asymptomatic in all patients during the pregnancy and delivery, whether vaginal or surgical. Neonatal platelet counts (n = 18) were normal (270,700/microliters +/- 69,900), and none of the newborns (n = 24) had a bleeding diathesis. Normalization of the platelet count (i.e., > 150,000/microliters) was documented in 18 patients within 1 month postpartum, in five within 3 months postpartum, and in two as late as 5 months after delivery. One woman did not recover from the thrombocytopenia and eventually developed other stigmata of an autoimmune disease. Long-term follow-up showed recurrence of thrombocytopenia in four patients: three in the context of a subsequent pregnancy and one who developed idiopathic thrombocytopenic purpura. Retrospective analysis of blood counts obtained from 12 previous pregnancies demonstrated thrombocytopenia of a similar degree to the index pregnancy. We conclude that gestational thrombocytopenia of < 100,000/microliters is clinically a benign phenomenon that can recur in subsequent pregnancies and is not accompanied by neonatal thrombocytopenia. In some cases, however, pregnancy-associated thrombocytopenia may be a manifestation of an autoimmune disease with its attendant implications for the neonate. Since the differential diagnosis between the two conditions may be difficult to establish when first encountered during pregnancy, a conservative approach emphasizing careful surveillance and guarded reassurance is justified as long as the platelet counts are > 50,000/microliters.
我们识别出22名在孕期偶然发现血小板计数低于100,000/微升的女性，并对她们产后至少6个月的血小板计数和临床结局进行了前瞻性监测。在研究期间，4名女性怀孕两次，共计26次妊娠。孕期最低血小板计数为65,600/微升±19,400（均值±标准差），分娩时为84,500/微升±32,300（P<0.02）。在孕期及分娩期间，无论经阴道分娩还是手术分娩，所有患者的血小板减少症几乎均无症状。新生儿血小板计数（n = 18）正常（270,700/微升±69,900），且所有新生儿（n = 24）均无出血倾向。18名患者在产后1个月内血小板计数恢复正常（即>150,000/微升），5名在产后3个月内恢复正常，2名直至分娩后5个月才恢复正常。1名女性的血小板减少症未恢复，最终出现了自身免疫性疾病的其他体征。长期随访显示，4名患者血小板减少症复发：3名在随后的妊娠期间复发，1名发展为特发性血小板减少性紫癜。对之前12次妊娠的血细胞计数进行回顾性分析显示，血小板减少程度与本次妊娠相似。我们得出结论，孕期血小板计数低于100,000/微升在临床上是一种良性现象，可在随后的妊娠中复发，且不伴有新生儿血小板减少症。然而，在某些情况下妊娠相关血小板减少症可能是自身免疫性疾病的一种表现，并对新生儿产生相应影响。由于在孕期首次遇到这两种情况时可能难以进行鉴别诊断，只要血小板计数>50,000/微升，采取强调密切监测和谨慎安慰的保守方法是合理的。
