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Journal of Obstetrics and Gynaecology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ijog20
Is incidental gestational thrombocytopaenia really always safe for the neonate? a
b
b
O. Pourrat , G. Valère & F. Pierre a
University of Poitiers, Faculty of Medecine, Poitiers, France; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit, Poitiers, France b
CHU Poitiers, Department of Gynecology and Obstetrics, Poitiers, France Published online: 15 May 2014.
Click for updates To cite this article: O. Pourrat, G. Valère & F. Pierre (2014) Is incidental gestational thrombocytopaenia really always safe for the neonate?, Journal of Obstetrics and Gynaecology, 34:6, 499-500 To link to this article: http://dx.doi.org/10.3109/01443615.2014.915293
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Journal of Obstetrics and Gynaecology, August 2014; 34: 499–500 © 2014 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2014.915293
OBSTETRIC SHORT COMMUNICATION
Is incidental gestational thrombocytopaenia really always safe for the neonate? O. Pourrat1, G. Valère2 & F. Pierre2 1University of Poitiers, Faculty of Medecine, Poitiers, France; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit,
Downloaded by [University of Manitoba Libraries] at 13:18 01 September 2015
Poitiers, France and 2CHU Poitiers, Department of Gynecology and Obstetrics, Poitiers, France
It is widely admitted that neonates’ platelet counts (PCs) are always normal in babies born to mothers with incidental gestational thrombocytopaenia. However, results of PC determinations at delivery have led us to wonder whether incidental gestational thrombocytopaenia is actually safe for the neonate under all circumstances, and to recommend that for every baby born to a mother with a pregnancy-associated thrombocytopaenia, even in the case of confirmed IGT, platelet counts on umbilical cord blood be closely monitored. Keywords: Immune thrombocytopaenia, incidental gestational thrombocytopaenia, neonatal platelets, pregnancy-associated thrombocytopaenia
Table I. Low platelet counts at delivery in seven neonates.
Neonates’ PC at delivery (⫻ 109/l) Mothers’ PC at delivery (⫻ 109/l) Diagnosis of mothers
1
2
3
4
5
6
7
58
50
99
120
105
139
144
104
58
138
171
98
98
87
IGT
PE
IGT
IGT
IGT
IGT
ITP
PC, platelet counts; IGT, incidental gestational thrombocytopaenia; PE, pre-eclampsia; ITP, immune idiopathic purpura.
infection and toxic origin were ruled out). Low PC collected by the cord was defined as below 150 ⫻ 109/l.
Introduction It is widely admitted that neonate platelet counts (PCs) are always normal in babies born to mothers with incidental gestational thrombocytopaenia (IGT). All of the papers published on this topic have indicated there was no risk of low PC in the fetus (Burrows and Kelton 1988, 1993). However, in a recent personal prospective study (unpublished) on pregnancy-associated thrombocytopaenia, results of PC determinations at delivery have led us to wonder whether or not IGT is actually safe for the neonate under all circumstances.
Materials and methods PCs on the umbilical cord were determined in a prospective study in babies born to 58 mothers monitored on account of low PC (below 150 ⫻ 109/l). Immune idiopathic purpura (ITP) was defined by low PC before index pregnancy, below 150 ⫻ 109/l and not below 100 ⫻ 109/l since 150 ⫻ 109/l was the threshold recommended for defining ITP at the time of our study (British Committee for Standards in Haematology General Haematology Task Force 2003), and/or below 150 ⫻ 109/l before 20 weeks’ gestation or, if no previous PC result has been found, below 150 ⫻ 109/l, 45 days after delivery. Pre-eclampsia-associated thrombocytopaenia and HELLP syndrome were defined according to the usual criteria (Brown et al. 2001). IGT was defined by PC of the mother above 150 ⫻ 109/l before index pregnancy and/or above 150 ⫻ 109/l before 20 weeks’ gestation or, if no previous PC result has been found, 45 days after delivery, and if no alternative explanation of low PC has been found (pre-eclampsia, systemic disease,
Results Thrombocytopaenia in mothers was diagnosed as IGT in 34 cases, PE in 14, HELLP syndrome in two, ITP in seven and prelupus in one. Mean PC in the mothers with IGT was 131 ⫻ 109/l (extremes 69–171). A blood specimen at delivery could not be obtained in all the neonates, and seven samples could not be analysed because of blood clotting in vitro. In the 33 for whom a result could be obtained, the mean PC was 221 ⫻ 109/l (extremes 50–369). Seven babies had low PC, ranging from 58 to 144 ⫻ 109/l (Table I). None of them were infected. Five of them were born from four mothers with IGT (one twin gestation), one with ITP and one with pre-eclampsia. No baby required treatment for low PC.
Discussion The definition of low PC used for neonates in this study (below 150 ⫻ 109/l) might be challenged, since Wiedmeier et al. (2009) found in a very large series of 34,146 neonates, that the lower reference range (5th percentile) in late pre-term and term neonates was 123 ⫻ 109/l. However, it should be noted that these figures were established in the first 3 days of life, and not as soon as delivery, as was the case in our series, even when PCs were shown to increase immediately after birth (Wiedmeier et al. 2009). Moreover, PCs were below 123 ⫻ 109/l in five out of our seven cases. As suggested by our results, PCs are not always normal in babies born to mothers with IGT. Follow-up of the mothers long after delivery would be useful in this case, since it has been
Correspondence: O. Pourrat, University of Poitiers, Faculty of Medecine; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit, Poitiers, France. E-mail: [email protected]
500
O. Pourrat et al.
hypothesised that IGT may be a mild transient manifestation of ITP (George 2000). To conclude, we would recommend that for every baby born to a mother with a pregnancy-associated thrombocytopaenia, even in the case of confirmed IGT, platelet counts in umbilical cord blood should be closely monitored. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
Downloaded by [University of Manitoba Libraries] at 13:18 01 September 2015
British Committee for Standards in Haematology General Haematology Task Force. 2003. Guidelines for the investigation and management of
idiopathic thrombocytopenic purpura in adults, children and in pregnancy. British Journal of Haematology 120:574–596. Brown MA, Lindheimer MD, De Swiet M, Van Assche A, Moutquin JM. 2001. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertension in Pregnancy 20:IX–XIV. Burrows RF, Kelton JG. 1988. Incidentally detected thrombocytopenia in healthy mothers and their infants. New England Journal of Medicine 319:142–145. Burrows RF, Kelton JG. 1993. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. New England Journal of Medicine 329:1463–1466. George JN. 2000. Platelets. Lancet 355:1531–1539. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. 2009. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. Journal of Perinatology 29:130–136.
Journal of Obstetrics and Gynaecology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ijog20
Is incidental gestational thrombocytopaenia really always safe for the neonate? a
b
b
O. Pourrat , G. Valère & F. Pierre a
University of Poitiers, Faculty of Medecine, Poitiers, France; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit, Poitiers, France b
CHU Poitiers, Department of Gynecology and Obstetrics, Poitiers, France Published online: 15 May 2014.
Click for updates To cite this article: O. Pourrat, G. Valère & F. Pierre (2014) Is incidental gestational thrombocytopaenia really always safe for the neonate?, Journal of Obstetrics and Gynaecology, 34:6, 499-500 To link to this article: http://dx.doi.org/10.3109/01443615.2014.915293
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Journal of Obstetrics and Gynaecology, August 2014; 34: 499–500 © 2014 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2014.915293
OBSTETRIC SHORT COMMUNICATION
Is incidental gestational thrombocytopaenia really always safe for the neonate? O. Pourrat1, G. Valère2 & F. Pierre2 1University of Poitiers, Faculty of Medecine, Poitiers, France; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit,
Downloaded by [University of Manitoba Libraries] at 13:18 01 September 2015
Poitiers, France and 2CHU Poitiers, Department of Gynecology and Obstetrics, Poitiers, France
It is widely admitted that neonates’ platelet counts (PCs) are always normal in babies born to mothers with incidental gestational thrombocytopaenia. However, results of PC determinations at delivery have led us to wonder whether incidental gestational thrombocytopaenia is actually safe for the neonate under all circumstances, and to recommend that for every baby born to a mother with a pregnancy-associated thrombocytopaenia, even in the case of confirmed IGT, platelet counts on umbilical cord blood be closely monitored. Keywords: Immune thrombocytopaenia, incidental gestational thrombocytopaenia, neonatal platelets, pregnancy-associated thrombocytopaenia
Table I. Low platelet counts at delivery in seven neonates.
Neonates’ PC at delivery (⫻ 109/l) Mothers’ PC at delivery (⫻ 109/l) Diagnosis of mothers
1
2
3
4
5
6
7
58
50
99
120
105
139
144
104
58
138
171
98
98
87
IGT
PE
IGT
IGT
IGT
IGT
ITP
PC, platelet counts; IGT, incidental gestational thrombocytopaenia; PE, pre-eclampsia; ITP, immune idiopathic purpura.
infection and toxic origin were ruled out). Low PC collected by the cord was defined as below 150 ⫻ 109/l.
Introduction It is widely admitted that neonate platelet counts (PCs) are always normal in babies born to mothers with incidental gestational thrombocytopaenia (IGT). All of the papers published on this topic have indicated there was no risk of low PC in the fetus (Burrows and Kelton 1988, 1993). However, in a recent personal prospective study (unpublished) on pregnancy-associated thrombocytopaenia, results of PC determinations at delivery have led us to wonder whether or not IGT is actually safe for the neonate under all circumstances.
Materials and methods PCs on the umbilical cord were determined in a prospective study in babies born to 58 mothers monitored on account of low PC (below 150 ⫻ 109/l). Immune idiopathic purpura (ITP) was defined by low PC before index pregnancy, below 150 ⫻ 109/l and not below 100 ⫻ 109/l since 150 ⫻ 109/l was the threshold recommended for defining ITP at the time of our study (British Committee for Standards in Haematology General Haematology Task Force 2003), and/or below 150 ⫻ 109/l before 20 weeks’ gestation or, if no previous PC result has been found, below 150 ⫻ 109/l, 45 days after delivery. Pre-eclampsia-associated thrombocytopaenia and HELLP syndrome were defined according to the usual criteria (Brown et al. 2001). IGT was defined by PC of the mother above 150 ⫻ 109/l before index pregnancy and/or above 150 ⫻ 109/l before 20 weeks’ gestation or, if no previous PC result has been found, 45 days after delivery, and if no alternative explanation of low PC has been found (pre-eclampsia, systemic disease,
Results Thrombocytopaenia in mothers was diagnosed as IGT in 34 cases, PE in 14, HELLP syndrome in two, ITP in seven and prelupus in one. Mean PC in the mothers with IGT was 131 ⫻ 109/l (extremes 69–171). A blood specimen at delivery could not be obtained in all the neonates, and seven samples could not be analysed because of blood clotting in vitro. In the 33 for whom a result could be obtained, the mean PC was 221 ⫻ 109/l (extremes 50–369). Seven babies had low PC, ranging from 58 to 144 ⫻ 109/l (Table I). None of them were infected. Five of them were born from four mothers with IGT (one twin gestation), one with ITP and one with pre-eclampsia. No baby required treatment for low PC.
Discussion The definition of low PC used for neonates in this study (below 150 ⫻ 109/l) might be challenged, since Wiedmeier et al. (2009) found in a very large series of 34,146 neonates, that the lower reference range (5th percentile) in late pre-term and term neonates was 123 ⫻ 109/l. However, it should be noted that these figures were established in the first 3 days of life, and not as soon as delivery, as was the case in our series, even when PCs were shown to increase immediately after birth (Wiedmeier et al. 2009). Moreover, PCs were below 123 ⫻ 109/l in five out of our seven cases. As suggested by our results, PCs are not always normal in babies born to mothers with IGT. Follow-up of the mothers long after delivery would be useful in this case, since it has been
Correspondence: O. Pourrat, University of Poitiers, Faculty of Medecine; CHU Poitiers, Obstetric Clinic, Intensive Care and Internal Medicine Unit, Poitiers, France. E-mail: [email protected]
500
O. Pourrat et al.
hypothesised that IGT may be a mild transient manifestation of ITP (George 2000). To conclude, we would recommend that for every baby born to a mother with a pregnancy-associated thrombocytopaenia, even in the case of confirmed IGT, platelet counts in umbilical cord blood should be closely monitored. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
Downloaded by [University of Manitoba Libraries] at 13:18 01 September 2015
British Committee for Standards in Haematology General Haematology Task Force. 2003. Guidelines for the investigation and management of
idiopathic thrombocytopenic purpura in adults, children and in pregnancy. British Journal of Haematology 120:574–596. Brown MA, Lindheimer MD, De Swiet M, Van Assche A, Moutquin JM. 2001. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertension in Pregnancy 20:IX–XIV. Burrows RF, Kelton JG. 1988. Incidentally detected thrombocytopenia in healthy mothers and their infants. New England Journal of Medicine 319:142–145. Burrows RF, Kelton JG. 1993. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. New England Journal of Medicine 329:1463–1466. George JN. 2000. Platelets. Lancet 355:1531–1539. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. 2009. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. Journal of Perinatology 29:130–136.
