RATIONAL COMBINATION THERAPY WITH SIMULTANEOUS OPERATIONS FOR REFRACTORY IMMUNE THROMBOCYTOPENIA AND DURING PREGNANCY
- Authors: VINOGRADOVA M.A1, FEDOROVA T.A1, CHUPRYNIN V.D1, TYUTYUNNIK V.L1, KAN N.E1, VEREDCHENKO A.V1, KHILKEVICH E.G1,2
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Affiliations:
- Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
- I.M. Sechenov First Moscow State Medical University
- Issue: No 9 (2013)
- Pages: 118-122
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/247099
- ID: 247099
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Abstract
Background. Thrombocytopenia may complicate the course of up to 10% of pregnancies. Above 70% of the first detected thrombocytopenia cases are directly related to pregnancy. Glucocorticoid therapy in average daily therapeutic doses of 0.5-0.7 mg/kg is a basic treatment during pregnancy and for immune thrombocytopenia. Splenectomy is the basis for second-line therapy during pregnancy. Description. The paper describes two clinical cases of pregnant women with thrombocytopenia who underwent laparoscopic splenectomy after cesarean section. Both patients preoperatively received prednisolone and human immunoglobulin. In the first 24 hours after surgery, there was an increase in platelets from 28,000 to 111,000 in one woman and from 9х10 9 to 13х10 9/l in the other. The latter underwent cesarean section and laparoscopic splenectomy during reinfusion of autoerythrocytes and transfusion of 1000 ml of fresh frozen plasma and 8 doses of platelet concentrate. Outpatient romiplostim therapy that could maintain partial remission for 14 months was additionally performed. Conclusion. Simultaneous laparoscopic splenectomy during surgical delivery in pregnant women with severe refractory immune thrombocytopenia is effective and maximally safe due to its low invasiveness, less expected blood loss, and rapidest postoperative recovery as compared to an open access.
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About the authors
M. A VINOGRADOVA
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: m_vinogradova@oparina4.ru
Moscow
T. A FEDOROVA
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: t_fyodorova@oparina4.ru
Moscow
V. D CHUPRYNIN
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: v_chuprynin@oparina4.ru
Moscow
V. L TYUTYUNNIK
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: tyutyunnik@mail.ru
Moscow
N. E KAN
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of RussiaMoscow
A. V VEREDCHENKO
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: a_veredchenko@oparina4.ru
Moscow
E. G KHILKEVICH
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University
Email: e_khilkevich@oparina4.ru
Moscow
References
- Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br. J. Haematol. 2012; 158(1): 3—15.
- Provan D., Stasi R., Newland A.C., Blanchette V.S., Bolton-Maggs P., Bussel J.B. et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115(2): 168—86.
- Baili L., Khellaf M., Languille L., Godeau B., Michell M. Impact of pregnancy on the course of thrombocytopenic purpura: an observational study on 44 cases. Blood. 2009; 114(22): 1320.
- Fujimura K., Harada Y., Fujimoto T., Kuramoto A., Ikeda Y., Akatsuka J. et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int. J. Hematol. 2002; 75(4): 426—33.
- Ozkan H., Cetinkaya M., Köksal N., Ali R., Güneç A.M., Baytan B. et al. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. J. Perinatol. 2010; 30(1): 38—44.
- Gasim T. Immune thrombocytopenia in pregnancy: a reappraisal of obstetric management and outcome. J. Reprod. Med. 2011; 56: 163—8.
- Fujita A., Sakai R., Matsuura S., Yamamoto W., Ohshima R., Kuwabara H. et al. A retrospective analysis of obstetric patients with idiopathic thrombocytopenic purpura: a single center study. Int. J. Hematol. 2010; 92(3): 463—7.
- Belkin A., Levy A., Sheiner E. Perinatal outcomes and complications of pregnancy in women with immune thrombocytopenic purpura. J. Matern.-Fetal Neonatal Med. 2009; 22(11): 1081—5.
- McCrae K. Immune thrombocytopenia: no longer idiopathic. Cleveland Clin. J. Med. 2011; 78(6): 358—73.
- Vesely S.K., Perdue J.J., Rizvi M.A., Terrell D.R., George J.N. Management of adult patients with idiopathic thrombocytopenic purpura after failure of splenectomy. A systematic review. Ann. Intern. Med. 2004; 140: 112—20.
- Neylon A.J., Saunders P.W.G., Howard M.R., Proctor S.J., Taylor P.R.A. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br. J. Haematol. 2003; 122: 966—74.
- George J.N. Management of patients with refractory immune thrombocytopenic purpura. J. Thromb. Hemost. 2006; 4: 1664— 72.
- British Committee for Standards in Haematology. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br. J. Haematol. 2003; 120(4): 574—96.
- Kojouri K., Vesely S.K., Terrell D.R., George J.N. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic literature review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104: 2623—34.
- Carr J.M., Kruskall M.S., Kaye J.A., Robinson S.H. Efficacy of platelet transfusions in immune thrombocytopenia. Am. J. Med. 1986; 80: 1051—4.
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