Prevalence, Pregnancy Outcomes and Treatment Modalities of Immune Thrombocytopenia Mothers Over 5-years in a Tertiary Health Care Hospital in South India | Chapter 15 | Achievements and Challenges of Medicine and Medical Science Vol. 11

Background: It has been proposed that thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Treating pregnancy associated with ITP can be difficult.

Objective: The objectives were to determine the prevalence, pregnancy outcomes, and treatment modalities of ITP mothers over five years in a tertiary health care hospital in South India.

Methods: Our study was a retrospective record study, which looked into various aspects of obstetrical outcomes and complications in ITP mothers. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at St. Johns Medical Hospital, Bangalore were studied. Patients with acute and chronic ITP were included as per the Vicenza consensus conference and the criteria for differentiating primary from secondary forms of ITP was followed, with consideration of a new entity of ITP associated with the presence of antiphospholipid antibodies.

Results: The study identified 53 patients with ITP with a mean age of 25.6+4.6 years, age of diagnosis of ITP at 21.1+5.9 years and gestational age of 36.2+3 weeks. In our study 17 (32%) were acute and 36 (67.1%) were chronic ITP. In our study, 39.6% had a history of at least one prior pregnancy loss. Patients with ITP at 35-37 weeks were induced with PGE1 (35.7%) in comparison to those with PGE2 (p≤0.001). Post-partum haemorrage (PPH) was seen in 7.5% of the pregnancies and all four were mothers with chronic ITP. Severe preeclampsia in ITP mothers was seen in 2 (66.7%).  All the findings showed that there is no reliable maternal parameter to predict the susceptibility and the need for intervention in mothers with life-threatening thrombocytopenia and the complications it poses to the foetus. Hence, constant vigilance is required to establish a safe pregnancy outcome in mothers with ITP.

Conclusions: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in the foetus.

 

Author (s) Details

 

Shashikala Karanth
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Christy Vijay
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Chaitanya Harita
Department of Medicine, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Jaya S. Mol
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v11/3758

Systemic Lupus Erythematosus (SLE): As a Haematological Problem | Chapter 14 | Advancement and New Understanding in Medical Science Vol. 2

 This chapter gives some new observations on Systemic lupus erythematosus (SLE), based on case histories, after studying more than 400 cases in a referral centre. All these were patients who came as diagnostic problems and not with established diagnosis. SLE is a systemic autoimmune disease with multisystem involvement and is associated with significant morbidity and mortality. Genetic, immunological, endocrine, and environmental factors influence the loss of immunological tolerance against self-antigens leading to the formation of pathogenic autoantibodies that cause tissue damage through multiple mechanisms. SLE is the prototype of a systemic autoimmune disorders and is considered a rheumatological disorder, but our observations and studies have established that the commonest initial presentation in SLE is with haematological problems. Or they frequently present with concomitant haematological symptoms, even in the presence of other manifestations. This is only reasonable that the bulk of SLE clinical manifestations must be haematological in nature, because blood and blood vessels collectively carry more antigens than any other organ. The haematological presentations seen are Chronic ITP, Autoimmune Haemolysis, Autoimmune B12 deficiency, Iron deficiency anaemia, Evan’s syndrome, pancytopenia, MDS, refractory anaemias, Pure Red cell Aplasia, leukopenia, Antiphospholipid antibody syndrome, lymphadenopathy with or without Hepatosplenomegaly, acquired clotting factor deficiencies, HELLP syndrome, TTP, myelofibrosis etc. In young females, if they present with one autoimmune disorder, it could be SLE in evolution, even if the tests for SLE are initially negative. If two or more autoimmune disorders are coexisting, it is almost always SLE, irrespective of the age. The criteria used for the diagnosis of SLE also need revision for the simple reason that relying too much on the existing criteria often leads to missing the diagnosis. Our observation was that only very few patients satisfied the ACR criteria for diagnosis. Therefore, it is evident that by several ways SLE qualifies to be called as a haematological disorder or else it should be considered only as an Internal Medicine problem. The fact is that clinical judgment is superior to laboratory diagnosis, but we need both of them. An alternative criterion for the diagnosis of SLE, which we have developed, the Kozhikode Criteria’ is given in the end. The etiology of SLE is largely unknown, but the observations suggest that it could be due to improper diet, lifestyle and probably some problems in their environment.

Author(s) Details:

P. K. Sasidharan,
Department of Medicine and Hematology, Government Medical College, Kozhikode, Kerala, India.

Please see the link here: https://stm.bookpi.org/ANUMS-V2/article/view/13167