Anselmi Angeli R, Ronca S, Bechini F, Signorile P G, Plotti G
Divisione di Ostetricia e Ginecologia, Azienda Complesso Ospedaliero S. Filippo Neri, Roma.
Minerva Ginecol. 1996 Dec;48(12):557-63.
Immune thrombocytopenic purpura (ITP) is an autoimmune disorder with its highest frequency in young women in the reproductive years. An antepartum diagnosis of maternal thrombocytopenia has become more common because platelet counts are now included with routine complete blood cell counts. Sometimes platelet autoantibodies facilitate increased platelet destruction by the reticuloendothelial system especially the spleen. These autoantibodies (IgG) can cross the placenta and place the fetus at risk for thrombocytopenia and, sometimes, serious bleeding problems such as intracranial hemorrhage can occur. The treatment is performed by corticosteroids (prednisone) or intravenous immune gammaglobulin. Four patients with thrombocytopenia during pregnancy underwent medical treatment (prednisone 1 mg/kg/die). The results were successful. In one case only we did not have a clinical response after corticosteroid therapy. There were no intracranial hemorrhages; however the risk for the patients and fetal or neonatal hemorrhage is much lower than thought. Corticosteroid treatment is the first choice, but sometimes it can give a clinical negative response.
免疫性血小板减少性紫癜（ITP）是一种自身免疫性疾病，在育龄期年轻女性中发病率最高。由于现在血小板计数已纳入常规全血细胞计数，产前诊断出母体血小板减少症变得更为常见。有时血小板自身抗体会促使网状内皮系统尤其是脾脏增加对血小板的破坏。这些自身抗体（IgG）可穿过胎盘，使胎儿有患血小板减少症的风险，有时还可能出现严重的出血问题，如颅内出血。治疗方法为使用皮质类固醇（泼尼松）或静脉注射免疫球蛋白。4例孕期血小板减少的患者接受了药物治疗（泼尼松1毫克/千克/天）。结果是成功的。仅在1例患者中，皮质类固醇治疗后未出现临床反应。未发生颅内出血；然而，患者以及胎儿或新生儿出血的风险比想象的要低得多。皮质类固醇治疗是首选，但有时可能会出现临床阴性反应。
