Diagnosis:
Management of ITP in Pregnancy
• Immune thrombocytopenic purpura (ITP) is a clinical diagnosis of exclusion. Patients present with isolated low platelet counts without abnormalities in the red cell and white cell lineages. Other causes of thrombocytopenia should be excluded. For example, pseudothrombocytopenia (PTCP) should be excluded by examining the peripheral blood smear. In ITP, the bone marrow biopsy shows normal erythropoiesis and myelopoiesis and increased megakaryocytes.
• ITP is caused by autoantibodies against platelet antigens. The antibody-coated platelets are cleared by the reticuloendothelial system. Recent evidence suggests that there is a concomitant platelet production defect.
• First-line treatment of ITP in adults include corticosteroids, intravenous immunoglobulin (IVIG), and intravenous Rh immune globulin in Rh-positive patients. A longer course of corticosteroids is preferred over a shorter course of corticosteroids or IVIG. IVIG and Rh immunoglobulin are preferred, if steroids are contraindicated (e.g., uncontrolled diabetes mellitus).
• Pregnant patients should be treated in the same manner as adult patients, so corticosteroids and IVIG are suggested as first-line treatments. However, randomized controlled trials in pregnant patients have not been performed.
• When pregnant patients with ITP are delivering, the method of delivery is based on the current recommendations for the obstetric indication.
• Neonates born to women with ITP are at increased risk of thrombocytopenia.
