• Modern approaches for management of the refractory immune thrombocytopenia in pregnancy 

Modern approaches for management of the refractory immune thrombocytopenia in pregnancy 

PERINATOLOGIYA I PEDIATRIYA. 2016.4(68):12-14; doi 10.15574/PP.2016.68.12 
 

Modern approaches for management of the refractory immune thrombocytopenia in pregnancy 

Davydova I., Limanskaya A., Klimenko S., Mokrik A., Butenko L., Ogorodnyk A.

SI «Institute of Pediatrics, Obstetrics and Gynecology National Academy of Medical Sciences of Ukraine», Kiev

SI «Ukrainian Center of Radiation Medicine National Academy of Medical Sciences of Ukraine», Kiev 
 

Background. Thrombocytopenia per se is one of the hematological diseases, which demands the repeated thrombocytes infusion. The last tendencies in the management of this disease show the enhanced amount of the necessary thrombocytes doses for treatment and the worldwide trend for the declining of donors. 

Considerably to these facts the new approaches for the thrombocytopenia treatment have been organized within last two decades. One of them is the finding of the safe, appropriate and effective growth factor for platelets, which could significantly improve the level of thrombocytes.

The article describes the case of refractory ITP management in pregnancy. ITP diagnosed at 26 weeks of gestation, the platelet number at the time of diagnostics 20000. The other bone marrow disorders excluded by bone marrow biopsy. The in-patient of the High Risk Pregnancy Department (Obstetric Issues of the Extragenital Pathology) from the 28 weeks of pregnancy. Modern approaches for treatment of ITP was describe in the article. Pregnant received therapy according to the latest guidelines. Delivery in term of 33–34 weeks. Integrated treatment of thrombocytopenia.


Conclusions. The refractory ITP is a rare disease and could be occasionally seen during pregnancy, but the hemorrhagic complications could be extremely harmful for both mother and child and demand the preterm pregnancy termination. The management of refractory ITP during pregnancy should be performed according to the International recommendations for the thrombocytopenia treatment with all the reserve of the medications. The positive result of the ITP management and perinatal and obstetric outcomes has been achieved through the use of the entire arsenal of drugs, correct tactics of delivery with hemorrhage prevention be using the 4 T strategy and the adequate doses of the tranexamic acid (sangera) and rhTPO (Emaplug) (Yuriya-Farm, Ukraine). It was the first implementation of the subcutaneous rhTPO in parturient with refractory ITP in Ukraine.


Key words: immune thrombocytopenia, pregnancy, treatment of refractory immune thrombocytopenia, Emaplug, Sangera.


References

1. Imbach P, Crowther M. 2011. Thrombopoietin-receptor agonists for primary immune thrombocytopenia. N Engl J Med. 365(8): 734-41. https://doi.org/10.1056/NEJMct1014202; PMid:21864167

2. Neunert C, Lim W, Crowther M, Cohen A, Solberg LJr, Crowther MA. 2011. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 117(16): 4190-207. https://doi.org/10.1182/blood-2010-08-302984; PMid:21325604

3. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R. et al. 2010. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 115: 168-186. https://doi.org/10.1182/blood-2009-06-225565; PMid:19846889

4. Xu Zhang,Yajing Zhao, Xiaoqing Li et al. 2016, Feb. 16. Trombopoietin: a potential diagnostic indicator of immune thrombocytopenia in pregnancy. Oncotarget. 7(7): 7489-7496. PMid:26840092 PMCid:PMC4884934