İMMÜN TROMBOSİTOPENİYLE KOMPLİKE GEBELİKLERİN YÖNETİMİNDE BELİRLEYİCİLER

Year 2023, Volume: 86 Issue: 4, 295 - 301, 01.12.2023

Çiğdem Kunt İşgüder , Tuğba Saraç Sivrikoz , Mehtap Akın , Mustafa Törehan Aslan , Lütfiye Selçuk Uygur , Şule Birol İnce , İbrahim Kalelioğlu , Sevgi Beşışık , Recep Has , Alkan Yıldırım

Abstract

Amaç: Bu çalışma, gebelikte immün trombositopeni (İTP) yönetimini etkileyecek hematolojik ve obstetrik faktörleri belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: İTP nedeniyle hastanemizde tedavi edilen ve doğumu hastanemizde yaptırılan İTP ile komplike olmuş 54 gebelik retrospektif olarak incelenmiştir. Obstetrik sonuçlar için alt grup analizi, doğum anındaki (<50x103 /mm3 veya ≥50x103 /mm3 ) ve tanı anındaki (gebelik öncesi veya gebelik sırasında) trombosit sayısı ve neonatal trombosit sayısına (≤100x103 /mm3 veya >100x103 /mm3 ) göre yapılmıştır.
Bulgular: Doğumda trombosit sayısı <50x103 /mm3 olan gebeliklerde steroid uygulaması, intravenöz immünoglobulinler (İVİG) ile birlikte steroid kullanımı ve kan ürünleri transfüzyonu anlamlı olarak daha yüksek saptanmıştır (sırasıyla, p=0,020, p=0,020, p=0,004). Gebelik öncesi İTP tanısı alan hastalara göre gebelikte İTP tanısı alan hastalarda, gebelik esnasında transfüzyon ve vajinal doğum oranının anlamlı olarak daha yüksek, erken doğum oranının anlamlı olarak daha düşük olduğu ve doğum anındaki gebelik yaşı, doğum ağırlığı ve neonatal trombosit sayısının anlamlı olarak daha yüksek olduğu belirlenmiştir (sırasıyla, p=0,041, p=0,048, p=0,044, p=0,020, p=0,002 ve p=0,002). Trombosit sayısı ≤100x103 /mm3 olan yenidoğanlarda maternal splenektomi öyküsü, yoğun bakım gereksinimi, IVIG tedavisi ve kan transfüzyon gereksinimi anlamlı olarak daha yüksek bulunmuştur (sırasıyla p=0,028, p=0,001, p=0,001 ve p=0,025).
Sonuç: Gebelik öncesi İTP tanısı alan kadınlar ve gebelik sırasında İTP tanısı konulan kadınlar, postpartum kanama bakımından benzerdir. Buna karşılık, gebelik sırasında İTP gelişen kadınların gereğinden fazla tedavi edilmesine yönelik bir eğilim söz konusudur.

Keywords

İmmun trombositopeni, gebelik, kanama

THE DETERMINANTS IN THE MANAGEMENT OF PREGNANCIES COMPLICATED WITH IMMUNE THROMBOCYTOPENIA

Abstract

Objective: This study aims to determine the hematologic and obstetric factors that would affect the management of immune thrombocytopenia (ITP) during pregnancy.
Material and Method: This is a retrospective review of 54 pregnancies that were complicated by ITP at a single tertiary center. All of the patients were followed-up and delivered at the same center. Subgroup analysis for obstetric outcomes was made according to the platelet counts at the time of delivery (<50x103/mm3 or ≥50x103 /mm3 ), the time of diagnosis (before or during pregnancy) and neonatal platelet counts (≤100x103 /mm3 or >100x103 /mm3 ).
Result: Transfusion of blood products, steroid administration per se, or in combination with intravenous immunoglobulins (IVIG), were significantly more often administered in those with platelet counts <50x103 /mm3 at the time of delivery (p=0.020, p=0.020, and p=0.004, respectively). The patients who were first diagnosed with ITP during pregnancy had higher rates of transfusion of blood products (p=0.041), higher rates of vaginal deliveries (p=0.048), and lower rates of preterm delivery (p=0.044) when compared to the patients who had ITP diagnosed before the on set of pregnancy. Gestational age at birth (p=0.020), birth weight (p=0.002) and neonatal platelet count (p=0.002) were significantly higher in those who were diagnosed during the pregnancy. History of maternal splenectomy, intensive care unit admission, IVIG administration, and blood transfusion were significantly more frequent in neonates with platelet counts ≤100x103 /mm3 (p=0.028, p=0.001, p=0.001, and p=0.025, respectively).
Conclusion: The women diagnosed with ITP before the pregnancy and those who were diagnosed during the pregnancy had comparable rates of postpartum bleeding. However, there was a tendency towards overtreatment of the women who developed ITP during pregnancy.

Keywords

Immune thrombocytopenia, pregnancy, bleeding

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