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1.
Medicine (Baltimore) ; 99(28): e21198, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664166

RESUMO

INTRODUCTION: Kasabach-Merritt Syndrome (KMS) is an extremely rare disease in adults, which lead to consumptive coagulopathy characterized by severe hypofibrinogenemia and thrombocytopenia. PATIENT CONCERNS:: a 25-year-old Chinese pregnant women complicated by preeclampsia and KMS presented with refractory postpartum hemorrhage and incision bleeding after cesarean section. DIAGNOSIS: The diagnosis of KMS was made based on clinical manifestation of Kaposiform Hemangioendothelioma, severe hypofibrinogenemia and thrombocytopenia. INTERVENTIONS: After a poor response to massive blood products transfusion for 1 week, corticosteroid treatment was initiated for 3 days. OUTCOMES: The patient reached a normal platelet count and a mild anemia within 4 weeks. Two months later, all laboratory values had returned to normal, and the incision was healing well. CONCLUSION: Pregnancy complicated by preeclampsia and surgery may have contributions for the development of Kasabach-Merritt syndrome. Corticosteroid is indicated in the episode of acute Kasabach-Merritt syndrome after the failure of massive blood transfusion.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Kasabach-Merritt/terapia , Hemorragia Pós-Parto/tratamento farmacológico , Pré-Eclâmpsia/terapia , Complicações Hematológicas na Gravidez/terapia , Adulto , Cesárea , Feminino , Humanos , Síndrome de Kasabach-Merritt/complicações , Hemorragia Pós-Parto/etiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações Hematológicas na Gravidez/etiologia
3.
J Thromb Haemost ; 18(7): 1648-1652, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32302459

RESUMO

We present a putative link between maternal COVID-19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS-CoV-2 has already resulted in high numbers of critically ill patients and deaths in the non-pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID-19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D-dimers, prothrombin time, and platelet count in all patients presenting with COVID-19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS-CoV-2-positive pregnant women are vital, as their derangement may signal a more severe COVID-19 infection, and may warrant pre-emptive admission and consideration of delivery to achieve maternal stabilization.


Assuntos
Betacoronavirus/patogenicidade , Coagulação Sanguínea , Infecções por Coronavirus/virologia , Coagulação Intravascular Disseminada/virologia , Pneumonia Viral/virologia , Complicações Hematológicas na Gravidez/virologia , Complicações Infecciosas na Gravidez/virologia , Adulto , Testes de Coagulação Sanguínea , Técnicas de Laboratório Clínico , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/terapia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Terceiro Trimestre da Gravidez/sangue , Resultado do Tratamento , Adulto Jovem
4.
Lakartidningen ; 1172020 01 23.
Artigo em Sueco | MEDLINE | ID: mdl-31990364

RESUMO

A program for care of women with immune thrombocytopenic purpura (ITP) with the recommendation to avoid treatment if platelets were >20 × 109/l during pregnancy, with the target level 100 × 109/l at delivery, was introduced. Treatment should be given with intravenous immunoglobulin (IVIG) or corticosteroids. Out of 75 pregnancies with ITP, 39 percent were treated and the treatment period was shorter with IVIG. Blood loss at delivery was similar as the reference population. Epidural analgesia was given in only 17 percent of the vaginal deliveries. Twenty-three percent of the infants had platelet counts less than 50 × 109/l during the first days after birth. If the women had prior neonatal trombocytopenia 63 percent got a child with thrombocytopenia and 40 percent of those with platelets <20 × 109/l during pregnancy had a child with thrombocytopenia. Multidisciplinary care of pregnant women with ITP including obstetricians, hematologists and neonatologists is recommended.


Assuntos
Complicações Hematológicas na Gravidez , Púrpura Trombocitopênica Idiopática , Criança , Feminino , Humanos , Imunoglobulinas Intravenosas , Contagem de Plaquetas , Gravidez , Complicações Hematológicas na Gravidez/terapia , Púrpura Trombocitopênica Idiopática/terapia
5.
Obstet Gynecol ; 135(1): 46-58, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809447

RESUMO

OBJECTIVE: To evaluate disease presentation, diagnosis, treatment, and clinical outcomes in pregnancy-associated atypical hemolytic uremic syndrome (aHUS). DATA SOURCES: We searched PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, Web of Science, EMBASE and Google Scholar, from inception until March 2018. METHODS OF STUDY SELECTION: We included English-language articles describing aHUS in pregnancy or postpartum. The diagnosis of aHUS was characterized by hemolysis, thrombocytopenia, and renal failure and was distinguished from typical diarrhea-associated hemolytic uremic syndrome. Patients were excluded if individual data could not be obtained, the diagnosis was unclear, or an alternative etiology was more likely, such as thrombotic thrombocytopenic purpura or Shiga toxin-producing Escherichia coli. Reports were appraised by two reviewers, with disagreements adjudicated by a third reviewer. TABULATION, INTEGRATION, AND RESULTS: The search identified 796 articles. After review of titles, abstracts, and full text, we identified 48 reports describing 60 unique cases of pregnancy-associated aHUS, with 66 pregnancies. Twelve cases involved pregnancy in women with known aHUS, and 54 cases involved first-episode pregnancy-associated aHUS. Women with known aHUS, particularly those with baseline creatinine at or above 1.5 mg/dL, had a high rate of adverse pregnancy outcomes. For first-episode pregnancy-associated aHUS, diagnosis most often occurred postpartum (94%), after a cesarean delivery (70%), in nulliparous women (58%). Preceding obstetric complications were common and included fetal death, preeclampsia, and hemorrhage. Diagnosis was usually made clinically, based on the triad of microangiopathic hemolysis, thrombocytopenia, and renal failure. Additional testing included renal biopsy, complement genetic testing, and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) testing. Treatment modalities included corticosteroids, plasma exchange, dialysis, and eculizumab. More women with first-episode pregnancy-associated aHUS achieved disease remission when treated with eculizumab, compared with those not treated with eculizumab (88% vs 57%, P=.02). CONCLUSION: Pregnancy-associated aHUS usually presents in the postpartum period, often after a pregnancy complication, and eculizumab is effective for achieving disease remission. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019129266.


Assuntos
Síndrome Hemolítico-Urêmica Atípica/diagnóstico , Síndrome Hemolítico-Urêmica Atípica/terapia , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Anticorpos Monoclonais Humanizados/uso terapêutico , Inativadores do Complemento/uso terapêutico , Feminino , Humanos , Troca Plasmática , Período Pós-Parto , Gravidez , Diálise Renal
7.
Rinsho Ketsueki ; 60(9): 1292-1298, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597855

RESUMO

This paper describes diagnosis, treatment, and control of acute venous thromboembolism (VTE) and antithrombotic prophylactic management during pregnancy and puerperium, especially in women with inherited thrombophilia. VTE is currently one of the three main causes of maternal morbidity in Japan. With approximately 0.05%-0.08% incidence rate per total number of births, it is becoming increasingly comparable with other developed countries. Pregnancy is characterized by high blood clotting potential due to increased coagulation factors, decreased anticoagulant activity, and fibrinolysis. Additionally, unique obstetric risk factors exist, such as cesarean section, prolonged bed rest, obesity, preeclampsia, and dehydration due to hyperemesis. Moreover, notable risk factors for VTE in pregnancy and puerperium for patients with inherited thrombophilia (e.g., deficiencies in antithrombin, protein C, and protein S) and acquired thrombophilia (e.g., antiphospholipid antibodies, history of VTE) have been reported; this study describes inherited thrombophilia in details.


Assuntos
Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Trombofilia/terapia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Cesárea , Gerenciamento Clínico , Feminino , Humanos , Japão , Gravidez , Fatores de Risco
8.
Clin Appl Thromb Hemost ; 25: 1076029619880262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31595781

RESUMO

Factor XI (FXI) deficiency is an uncommon autosomal disorder with variable bleeding phenotype, making peripartum management challenging. We describe our experience in pregnant women with FXI deficiency and identify strategies to minimize the use of hemostatic agents and increase utilization of neuraxial anesthesia. Electronic records of 28 pregnant women with FXI deficiency seen by a hematology service in an academic medical center from January 2006 to August 2018 were reviewed. Data on bleeding, obstetric history, peripartum management, and FXI activity were collected. Partial FXI deficiency was defined as >20 IU/dL and severe <20 IU/dL. Median FXI activity was 42 IU/dL (range <1-73 IU/dL), and median activated partial thromboplastin time was 32.2 seconds (range: 27.8-75 seconds). There were 64 pregnancies: 53 (83%) live births and 11 (17%) pregnancy losses. Postpartum hemorrhage occurred in 9 (17%) pregnancies. Antifibrinolytic agents and fresh frozen plasma were used only in women with severe deficiency (42% with bleeding and 17% with no bleeding phenotype, respectively). Neuraxial anesthesia was successfully administered in 32 (59%) deliveries. Most women with FXI deficiency have uncomplicated pregnancies and deliveries with minimal hemostatic support. Neuraxial anesthesia can be safely administered in most women.


Assuntos
Deficiência do Fator XI/sangue , Período Periparto , Período Pós-Parto , Adulto , Anestesia/métodos , Antifibrinolíticos/uso terapêutico , Gerenciamento Clínico , Registros Eletrônicos de Saúde , Deficiência do Fator XI/terapia , Feminino , Hemostáticos/uso terapêutico , Humanos , Plasma , Hemorragia Pós-Parto/etiologia , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/terapia , Resultado da Gravidez
9.
Int J Gynaecol Obstet ; 147(3): 363-367, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489626

RESUMO

OBJECTIVE: To study the contribution of blood transfusion management in the improvement of maternal and perinatal outcomes in pregnant women with sickle cell disease in Ouagadougou. METHODS: A cross-sectional retrospective study with data collected from February 2012 to January 2014 was used. Patients were differentiated into three groups: patients with at least one exchange transfusion, patients who received blood transfusion, and patients who did not receive any transfusion. Data were collected from patients' patient care documents. RESULTS: One hundred and sixty-four patients were included, of whom 53 were in the first group, 32 in the second group, and 79 in the third group. Maternal complications in the last trimester of pregnancy were significantly less important (P=0.000) in the first group (58.5%) than in the second (78.5%) and third group (91.1%). The same trend was observed for postpartum maternal mortality (5.7%; 12.5%; 12.6%; P=0.009). Fetal complications such as preterm birth and early neonatal death were lower in the first group (15.1%; 1.8%) than in the second (40.6%; 23.1%) and third group (32.9%; 7.6%). CONCLUSION: Prophylactic blood transfusion is an important part of the management of pregnant patients with sickle cell disease.


Assuntos
Anemia Falciforme/terapia , Transfusão de Sangue/métodos , Complicações Hematológicas na Gravidez/terapia , Adulto , Burkina Faso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Morte Materna/prevenção & controle , Morte Perinatal/prevenção & controle , Gravidez , Terceiro Trimestre da Gravidez , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos
10.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229978

RESUMO

A rare case of acquired amegakaryocytic thrombocytopenia (AATP) in a 35-year-old woman who presented with anaemia and thrombocytopenia at 22 weeks gestation. The first diagnostic impression was of an evolving aplastic anaemia; however, the patient was simultaneously diagnosed with severe vitamin B12 deficiency in the setting of vegetarianism. Once the cyanocobalamin deficiency was corrected, a repeat bone marrow biopsy revealed an isolated depletion of megakaryocytes, which suggested the diagnosis of AATP. Supportive care was provided for her anaemia and thrombocytopenia and she delivered a healthy baby girl with a normal platelet count. The patient was subsequently started on romiplostim with steady improvement in her platelet counts. This rare AATP case presentation highlights the importance of a well-structured diagnostic approach to thrombocytopenia during pregnancy and supports the successful use of thrombopoietin agonists for the management of AATP.


Assuntos
Doenças da Medula Óssea/complicações , Complicações Hematológicas na Gravidez/fisiopatologia , Púrpura Trombocitopênica/complicações , Receptores Fc/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Trombocitopenia/etiologia , Trombopoetina/uso terapêutico , Adulto , Doenças da Medula Óssea/fisiopatologia , Doenças da Medula Óssea/terapia , Cesárea , Feminino , Humanos , Contagem de Plaquetas , Gravidez , Complicações Hematológicas na Gravidez/terapia , Púrpura Trombocitopênica/fisiopatologia , Púrpura Trombocitopênica/terapia , Trombocitopenia/fisiopatologia , Trombocitopenia/terapia , Resultado do Tratamento
11.
Glob Health Action ; 12(1): 1621589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31203791

RESUMO

Background: Anaemia in pregnancy is typically due to iron deficiency (IDA) but remains a complex and pervasive problem, particularly in low resource settings. At clinics on the Myanmar-Thailand border, a protocol was developed to guide treatment by health workers in antenatal care (ANC). Objective: To evaluate the clinical use of a protocol to treat anaemia in pregnancy. Methods: The design was a descriptive retrospective analysis of antenatal data obtained during the use of a standard anaemia treatment protocol. Two consecutive haematocrits (HCT) <30% prompted a change from routine prophylaxis to treatment doses of haematinics. Endpoints were anaemia at delivery (most recent HCT before delivery <30%) and timeliness of treatment initiation. Women whose HCT failed to respond to the treatment were investigated. Results: From August 2007 to July 2012, a median [IQR] of five [4-11] HCT measurements per woman resulted in the treatment of anaemia in 20.7% (2,246/10,886) of pregnancies. Anaemia at delivery was present in 22.8% (511/2,246) of treated women and 1.4% (123/8,640) who remained on prophylaxis. Human error resulted in a failure to start treatment in 97 anaemic women (4.1%, denominator 2,343 (2,246 + 97)). Fluctuation of HCT around the cut-point of 30% was the major problem with the protocol accounting for half of the cases where treatment was delayed greater than 4 weeks. Delay in treatment was associated with a 1.5 fold higher odds of anaemia at delivery (95% CI 1.18, 1.97). Conclusion: There was high compliance to the protocol by the health workers. An important outcome of this evaluation was that the clinical definition of anaemia was changed to diminish missed opportunities for initiating treatment. Reduction of anaemia in pregnancy requires early ANC attendance, prompt treatment at the first HCT <30%, and support for health workers.


Assuntos
Anemia/terapia , Protocolos Clínicos/normas , Guias de Prática Clínica como Assunto , Complicações Hematológicas na Gravidez/terapia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Mianmar , Gravidez , Estudos Retrospectivos , Tailândia , Adulto Jovem
12.
Rinsho Ketsueki ; 60(3): 209-212, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31068517

RESUMO

A 30-year-old woman who was 14 weeks pregnant was admitted to our hospital due to purpura, nasal bleeding, and abdominal pain. She was diagnosed with acquired thrombotic thrombocytopenic purpura (TTP) based on the presence of hemolytic anemia, thrombocytopenia, decreased ADAMTS 13 activity (<0.01 IU/ml), and high ADAMTS 13 inhibitor levels (4.8 BU/ml). Plasma exchange (PE) and steroid therapy were immediately administered. However, because she did not respond to these therapeutic approaches, rituximab was additionally administered on the sixth day of treatment. The level of ADAMTS 13 inhibitor increased to 12.5 BU/ml on the seventh day. Renal insufficiency, disturbed consciousness, and genital bleeding did not improve in spite of daily PE, steroid therapy, and second dose of rituximab. She finally died after sudden convulsions on the 14th day. Although the treatment outcomes of TTP have remarkably improved, some cases are refractory to therapy. Establishment of adequate treatment strategies for acquired TTP in pregnant women is required.


Assuntos
Proteína ADAMTS13/antagonistas & inibidores , Troca Plasmática , Complicações Hematológicas na Gravidez/terapia , Púrpura Trombocitopênica Trombótica/terapia , Rituximab , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez , Resultado do Tratamento
13.
Eur J Haematol ; 103(2): 73-79, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107984

RESUMO

Given the wide heterogeneity of phenotypes and of the underlying pathophysiological mechanisms associated with the disorder, pregnancy and delivery in von Willebrand disease (VWD) represent a significant clinical challenge. The variable pattern of changes observed during pregnancy of von Willebrand factor (VWF) and factor VIII (FVIII), the protein carried by VWF, prompts a careful evaluation of pregnant women with VWD to plan the most appropriate treatment at the time of parturition. However, there are also instances during pregnancy (amniocentesis, vaginal bleeding associated with placental detachment, sudden abortion) that may require urgent hemostatic treatment to prevent bleeding. Thus, women with VWD should start pregnancy after being well characterised as to their type, subtype and treatments. Women with VWD who have VWF and FVIII basal levels >30 U/dL typically normalise these levels at the end of pregnancy and specific anti-haemorrhagic prophylaxis is seldom required. On the contrary, those with basal levels <20 U/dL usually show a lesser increase and specific treatment is required. Some women with DNA variants associated with increased clearance can be treated with desmopressin, while those unresponsive or with contra-indications to this agent need replacement therapy. For these latter women, the risk of vaginal bleeding during pregnancy may be increased and prophylaxis with VWF concentrates required. Similarly, women with type 2 VWD who maintain reduced VWF activity throughout pregnancy require replacement therapy with FVIII/VWF concentrates. Delayed postpartum bleeding may occur when replacement therapy is not continued for some days. Tranexamic acid is useful at discharge to avoid excessive lochia.


Assuntos
Parto Obstétrico , Parto , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/terapia , Amniocentese , Biópsia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Gerenciamento Clínico , Fator VIII , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Parto/sangue , Período Pós-Parto , Guias de Prática Clínica como Assunto , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/epidemiologia , Risco , Doenças de von Willebrand/sangue , Doenças de von Willebrand/epidemiologia , Fator de von Willebrand
15.
Saudi Med J ; 40(4): 397-400, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30957135

RESUMO

Ovarian teratoma is a rare cause of autoimmune hemolytic anemia (AIHA) by warm antibodies, resistant to corticosteroid therapy. This also implies that ovarian teratoma should be included in the differential diagnosis of AIHA, whether or not associated with pregnancy. We present a case of a primigravida who presented with ovarian dermoid cysts and AIHA at 24 weeks of gestation. The patient received corticosteroids, intravenous immunoglobulin, rituximab, and multiple blood transfusions, with no significant improvement. Hemoglobin levels returned to normal only after laparoscopic ovarian cystectomy. Autoimmune hemolytic anemia caused by dermoid cyst is a rare condition especially in pregnancy. However, in light of similar case reports and review of the existing literature, we conclude that surgical excision should be considered when AIHA and ovarian teratoma coexist.


Assuntos
Anemia Hemolítica Autoimune/etiologia , Anemia Hemolítica Autoimune/terapia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/terapia , Ovariectomia/métodos , Complicações Hematológicas na Gravidez/etiologia , Complicações Hematológicas na Gravidez/terapia , Complicações Neoplásicas na Gravidez/cirurgia , Teratoma/complicações , Teratoma/terapia , Adulto , Anemia Hemolítica Autoimune/diagnóstico , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico , Ovário/cirurgia , Período Pós-Parto , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Resultado da Gravidez , Teratoma/diagnóstico , Resultado do Tratamento , Adulto Jovem
16.
Harefuah ; 158(3): 184-186, 2019 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-30916507

RESUMO

INTRODUCTION: Acquired hemophilia A is a rare disease. The incidence has been estimated to be 1.3-1.5 cases per 1 million persons per year. The etiology of acquired hemophilia A varies. It may develop in patients with autoimmune disorders, hematologic and solid cancers or in women during pregnancy or following childbirth. In about half of the cases no underlying disease can be found. The clinical picture is dominated by severe soft tissue hematomas especially in the cases of pregnancy-related acquired hemophilia A. Unlike congenital hemophilia A, bleeding into joints is rare. Pregnancy-related acquired hemophilia A may develop following any pregnancy but is observed more often in primigravidas. In most cases it arises in the postpartum period, most commonly 1-4 months after delivery. If factor VIII inhibitors develop during pregnancy or labor, they are frequently associated with severe uterine bleeding. The prognosis of pregnancy-related acquired hemophilia A is good with a high percentage of spontaneous remissions especially if the inhibitor was detected postpartum. Patients with acquired inhibitors do not usually have personal or family history of bleeding tendency, thus it is the presence of bleeding at multiple sites with prolonged activated partial thromboplastin time not corrected by incubation with normal plasma (mixing study) that raises the suspicion of inhibitor. Prompt diagnosis and treatment achieved by close collaboration among gynecologists and hematologists may improve the prognosis and prevent severe bleeding.


Assuntos
Doenças Autoimunes , Hemofilia A , Complicações Hematológicas na Gravidez , Autoanticorpos , Fator VIII , Feminino , Hemofilia A/diagnóstico , Hemofilia A/terapia , Hemorragia , Humanos , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia
17.
Med J Aust ; 210(7): 326-332, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30924538

RESUMO

INTRODUCTION: There have been significant advances in the understanding of the management of inherited bleeding disorders in pregnancy since the last Australian Haemophilia Centre Directors' Organisation (AHCDO) consensus statement was published in 2009. This updated consensus statement provides practical information for clinicians managing pregnant women who have, or carry a gene for, inherited bleeding disorders, and their potentially affected infants. It represents the consensus opinion of all AHCDO members; where evidence was lacking, recommendations have been based on clinical experience and consensus opinion. MAIN RECOMMENDATIONS: During pregnancy and delivery, women with inherited bleeding disorders may be exposed to haemostatic challenges. Women with inherited bleeding disorders, and their potentially affected infants, need specialised care during pregnancy, delivery, and postpartum, and should be managed by a multidisciplinary team that includes at a minimum an obstetrician, anaesthetist, paediatrician or neonatologist, and haematologist. Recommendations on management of pregnancy, labour, delivery, obstetric anaesthesia and postpartum care, including reducing and treating postpartum haemorrhage, are included. The management of infants known to have or be at risk of an inherited bleeding disorder is also covered. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Key changes in this update include the addition of a summary of the expected physiological changes in coagulation factors and phenotypic severity of bleeding disorders in pregnancy; a flow chart for the recommended clinical management during pregnancy and delivery; guidance for the use of regional anaesthetic; and prophylactic treatment recommendations including concomitant tranexamic acid.


Assuntos
Transtornos Herdados da Coagulação Sanguínea/terapia , Fatores de Coagulação Sanguínea/uso terapêutico , Hemostáticos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Complicações Hematológicas na Gravidez/terapia , Anestesia Obstétrica/normas , Austrália , Transtornos Herdados da Coagulação Sanguínea/complicações , Consenso , Feminino , Humanos , Recém-Nascido , Equipe de Assistência ao Paciente , Gravidez , Sociedades Médicas
18.
Obstet Gynecol ; 133(3): e181-e193, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801473

RESUMO

Obstetricians frequently diagnose thrombocytopenia in pregnant women because platelet counts are included with automated complete blood cell counts obtained during routine prenatal screening (). Although most U.S. health care providers are trained using U.S. Conventional Units, most scientists, journals, and countries use Système International (SI) units. The laboratory results reported in U.S. Conventional Units can be converted to SI Units or vice versa by using a conversion factor. Given the conversion factor is 1.0, when converting from 10/µL to 10/L the platelet "count" does not seemingly change. Thrombocytopenia, defined as a platelet count of less than 150 × 10/L, is common and occurs in 7-12% of pregnancies at the time of delivery (). Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to pregnancy. Some causes of thrombocytopenia are serious medical disorders that have the potential for maternal and fetal morbidity. In contrast, other conditions, such as gestational thrombocytopenia, are benign and pose no maternal or fetal risks. Because of the increased recognition of maternal and fetal thrombocytopenia, there are numerous controversies about obstetric management of this condition. Clinicians must weigh the risks of maternal and fetal bleeding complications against the costs and morbidity of diagnostic tests and invasive interventions. This Practice Bulletin is a targeted revision to reflect limited changes to information about new estimates for thrombocytopenia in pregnancy and the risk of recurrence of fetal-neonatal alloimmune thrombocytopenia in subsequent pregnancies, and to provide new information on the level of thrombocytopenia that permits regional anesthesia.


Assuntos
Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/terapia , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/sangue , Trombocitopenia/sangue
19.
BMJ Case Rep ; 12(2)2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30782626

RESUMO

Intrauterine transfusion is one of the mainstays of treatment in isoimmunised pregnancies guided by the changes in middle cerebral artery Doppler of the fetus. The common postnatal complications associated with Rh isoimmunisation are high unconjugated bilirubin requiring blood exchange transfusions, cholestasis due to bile inspissation, thrombocytopenia and anaemia. Hyperferritinaemia is an uncommon adverse effect observed in Rh isoimmunised pregnancies. In this case report, we describe the clinical course of a Rh isoimmunised neonate with hyperferritinaemia and transfusion acquired cytomegalovirus disease which resolved. Iron chelation therapy was not necessary.


Assuntos
Transfusão de Sangue Intrauterina/efeitos adversos , Insuficiência de Crescimento/terapia , Sobrecarga de Ferro/diagnóstico , Fototerapia/métodos , Complicações Hematológicas na Gravidez/terapia , Isoimunização Rh/terapia , Adulto , Antivirais/uso terapêutico , Bilirrubina/sangue , Velocidade do Fluxo Sanguíneo , Transfusão de Sangue Intrauterina/métodos , Insuficiência de Crescimento/fisiopatologia , Feminino , Ferritinas/sangue , Humanos , Recém-Nascido , Sobrecarga de Ferro/fisiopatologia , Sobrecarga de Ferro/terapia , Artéria Cerebral Média , Gravidez , Complicações Hematológicas na Gravidez/fisiopatologia , Isoimunização Rh/complicações , Isoimunização Rh/fisiopatologia , Resultado do Tratamento , Valganciclovir/uso terapêutico
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