Ajzenberg N, Dreyfus M, Kaplan C, Yvart J, Weill B, Tchernia G
Departments of Biological Hematology and of Biophysics, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris et Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France.
Blood. 1998 Dec 15;92(12):4573-80.
Thrombocytopenia detected during pregnancy addresses the issue of its mechanism and of the possible occurrence of neonatal thrombocytopenia. To further investigate these issues, 50 women referred to us because of thrombocytopenia detected during pregnancy (platelet count, <150 x 10(9)/L), were extensively studied, as well as their offspring. Among these thrombocytopenic women, we used the threshold of 70 x 10(9)/L to differentiate between mild and severe thrombocytopenia. Whatever the severity of thrombocytopenia, we found biological features of an autoimmune disorder in 48% of the women, and chronic thrombocytopenia in 55%. A familial thrombocytopenia was evidenced in 1 case. These 50 women gave birth to 63 neonates, among whom 24 were thrombocytopenic, either at birth or during the first week of life. Neonatal thrombocytopenia could only be predicted in multiparous women, on the basis of previous neonatal thrombocytopenia in older siblings, and/or when maternal platelet life span study, performed before pregnancy, had evidenced an autoimmune thrombocytopenia (AITP)-like profile. These results suggest that, in case of pregnancy-associated thrombocytopenia, familial and immunological studies, combined with postdelivery iterative platelet counts, should be performed to properly characterize the thrombocytopenia. Moreover, the platelet count of the neonate should be carefully assessed at birth and during the following days, a platelet life span study should be performed after delivery in the mother, because these two parameters are likely to bring valuable information regarding the forthcoming pregnancies and the risk of neonatal thrombocytopenia.
孕期检测到的血小板减少症涉及到其发病机制以及新生儿血小板减少症可能发生的问题。为了进一步研究这些问题，我们对50名因孕期检测到血小板减少症（血小板计数<150×10⁹/L）而转诊至我们这里的女性及其后代进行了广泛研究。在这些血小板减少症女性中，我们以70×10⁹/L为阈值区分轻度和重度血小板减少症。无论血小板减少症的严重程度如何，我们发现48%的女性存在自身免疫性疾病的生物学特征，55%存在慢性血小板减少症。有1例证实为家族性血小板减少症。这50名女性共生育了63名新生儿，其中24名在出生时或出生后第一周出现血小板减少症。只有在经产妇中，根据年长同胞先前的新生儿血小板减少症，和/或在怀孕前进行的母体血小板寿命研究证实存在类似自身免疫性血小板减少症（AITP）的情况下，才能预测新生儿血小板减少症。这些结果表明，对于妊娠相关血小板减少症，应进行家族和免疫学研究，并结合产后反复血小板计数以准确描述血小板减少症的特征。此外，应在出生时及随后几天仔细评估新生儿的血小板计数，产后应对母亲进行血小板寿命研究，因为这两个参数可能会为未来的妊娠和新生儿血小板减少症的风险提供有价值的信息。
