ITP -Idiopathic Throbocytopenia an autoimmune pheninenon

•                 What may be the causes of thrombocytopenia in Pregancy??  Ans :The most cases is HELLP which means Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome . HELLP) syndrome is the most common pathologic cause of maternal thrombocytopenia. Members participation please .

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•                 For Junior members only Prevalence of HELLP ??  .How many of us keep HELLP in D/D of PPH and we continue to administer we oxytocics ,Balloon or PPH canula as discovered by friend Dr Samrath but withput any effect, So any case of intrapartum and or PPH we have to keep HELLP in D/D . HELLP t occurs in approx­imately 10% to 20% of women who have severe preeclampsia and is often an early finding in preeclampsia. Not all PPH are PPH , To please remember that platelets usually nadir at 24 to 48 hours after delivery but typically do not drop below 20,000/pLin undiagnosed HELLP .. In women who remain severely thrombocy­topenic after delivery, plasma exchange and/or corticosteroids may be considered. In addition to improving neonatal outcome before 34 weeks’ gestation, corticosteroids may also improve maternal outcomes. When given in the antepartum period, tran­sient improvements are seen in maternal platelet counts. Small placebo-controlled trials have not shown decreased morbidity when steroids are continued postpartum.

Antiplatelct antibodies are more dangerous than  Coronoa or recent Cyclone that hit West Bengal. Can junior members high light on Idiopathic Thrombocytopenic Purpura?? My son like Professor Dr Indranil  Dutta will highlight more in this regard, You may asl add on and share the wisdom & experiences as U  completed 3 yrs in PGT . How many cases U came acrroos such Idiopathic thrombocytopenic purpura??  My answer:-

•    ITP occurs in 1 to 2 per 1,000 pregnancies and accounts for 5% of pregnancy- associated thrombocytopenia. ITP is the most common cause of thrombocyto­penia in the first trimester. Antiplatelct antibodies arc directed at platelet surface

glycoproteins, leading to increased destruction of platelets by the reticuloendothe­lial system (primarily the spleen) that exceeds the rate of platelet synthesis by the bone marrow. The course of ITP is not typically affected by pregnancy.

•    How to diagnose  ITP??? Diagnosis: May first report with bruises or epistaxis or bleeding from venepunture!!! Diagnosis is based complete blood count, and peripheral smear. Women with ITP may report symptoms of easy bruising, petechiae, epistaxis, or gingival bleeding predating pregnancy. ITP is a diagnosis of exclusion, and there is no diagnostic test. If thrombocytopenia is mild, it is difficult to distinguish ITP from gestational thrombocytopenia. Detection of platelet-associated antibodies is consistent with, but not diagnostic of, ITP because they may also be present in women with gestational thrombo­cytopenia and prccclampsia. Platelet antibody testing has a fairly low sensitivity (49% to 66%). However, the absence of platelet-associated IgG makes the diag­nosis of ITP less likely. ITP is more likely if the platelet count is <50,000/p.L or in the presence of an underlying autoimmune disease or history of previous thrombocytopenia. In contrast to gestational thrombocytopenia, ITP-associated thrombocytopenia is typically evident early in pregnancy. Findings include the following:

• Persistent thrombocytopenia (platelet count <100,000/p.L with or without accompanying megathrombocytes on the peripheral smear)

• Normal or increased megakaryocytes determined from bone marrow

• Secondary causes of maternal thrombocytopenia should be excluded (e.g., pre­eclampsia, HIV infection, systemic lupus erythematosus, drugs).

• Absence of splenomegaly

•   How to treat such uncommon woman in pregancy?? When not to transfuse blood components?? Ans:-Preg­nant women with platelet counts over 50,000/p.L at any time during the pregnancy and those with counts of 30,000 to 50,000/p.L in the first or second trimester do not routinely require treatment. If the platelet count is <10,000/pL at any point in pregnancy, between 10,000 and 30,000/pL in the second or third trimester, or if the patient demonstrates bleeding symptoms, treatment is required. Two treatments are available: glucocorticoids and IV gamma globulin (IVIG).   What about steroids in this auto immune diosrders like rheumatoid arthtitis or SLE ?? Glucocorticoids suppress antibody production, inhibit sequestration of anti- body-coated platelets, and interfere with the interaction between platelets and antibodies.

°     Oral prednisone is started at 1 to 2 mg/kg/day and is tapered to the lowest dose supporting an acceptable platelet count (usually over 50,000/p.L) and tolerable side effect profile. Patients usually respond within 3 to 7 days and approximately 75% respond within 3 weeks. One fourth of patients may achieve complete remission.° High-dose glucocorticoids, such as methylprednisolone, may be administered at 1 to 1.5 mg/kg IV in divided doses. Very little crosses the placenta. Response is usually seen in 2 to 10 days.