Blood, Vol. 92 No. 12 (December 15), 1998:
pp. 4573-4580
Pregnancy-Associated Thrombocytopenia Revisited: Assessment and
Follow-Up of 50 Cases
Nadine Ajzenberg,
Marie Dreyfus,
Cécile Kaplan,
Jeannine Yvart,
Bernard Weill, and
Gil Tchernia
From the Departments of Biological Hematology and of Biophysics,
Hôpital Bicêtre, Assistance Publique-Hôpitaux de
Paris et Faculté de Médecine Paris-Sud, Le
Kremlin-Bicêtre, France; The Platelet Immunology Department,
INTS, Paris, France; and the Laboratory of Clinical Immunology,
Hôpital Cochin, Paris, France.
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 × 109/L), were extensively
studied, as well as their offspring. Among these thrombocytopenic
women, we used the threshold of 70 × 109/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.
