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Huisman EJ, Holle N, Schipperus M, Cnossen MH, de Haas M, Porcelijn L, Zwaginga JJ. Should HLA and HPA-matched platelet transfusions for patients with Glanzmann Thrombasthenia or Bernard-Soulier syndrome be standardized care? A Dutch survey and recommendations. Transfusion 2024; 64:824-838. [PMID: 38642032 DOI: 10.1111/trf.17824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Glanzmann thrombasthenia (GT) and Bernard-Soulier syndrome (BSS) patients require frequent platelet transfusions and hence have an increased risk for alloimmunization against donor Human Leukocyte Antigens (HLA) when no HLA-matching is performed. Knowing that Human Platelet Antigens (HPA) are located on the platelet glycoproteins that can be absent in these patients, preventive HPA-matching may also be considered. Uniform recommendations on this topic lack in transfusion guidelines making standard practice unclear, therefore, we aimed to provide a framework for matched platelet transfusions. STUDY DESIGN AND METHODS We conducted a targeted literature search and a national survey of Dutch (pediatric) hematologists from July to September 2021. RESULTS We found 20 articles describing platelet transfusion policies in 483 GT-patients and 29 BSS-patients, both adults and children. Twenty surveys were returned for full analysis. All responders treated patients with platelet disorders, including GT (n = 36 reported) and BSS (n = 29 reported). Of respondents, 75% estimated the risk of antibody formation as "likely" for HLA and 65% for HPA. Formation of HLA antibodies was reported in 5 GT and in 5 BSS-patients, including one child. Fifteen respondents gave preventive HLA-matched platelets in elective setting (75%). Three respondents additionally matched for HPA in GT-patients (15%). Main argument for matched platelet transfusions was preventing alloimmunization to safeguard the effectivity of 'random' donor-platelets in acute settings. CONCLUSION Elective HLA-matching for GT and BSS-patients is already conducted by most Dutch (pediatric) hematologists. HPA-matching is mainly applied when HPA-antibodies are formed. Based on the current literature and the survey, recommendations are proposed.
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Affiliation(s)
- Elise J Huisman
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Medical Affairs, Unit of Transfusion Medicine, Sanquin Blood bank, Amsterdam, The Netherlands
- Laboratory of Blood Transfusion, Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nory Holle
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin Schipperus
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Medical Affairs, Unit of Transfusion Medicine, Sanquin Blood bank, Amsterdam, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services and Sanquin Research, Amsterdam, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services and Sanquin Research, Amsterdam, The Netherlands
- Laboratory of Platelet and Leucocyte Serology, Sanquin Diagnostic Services and Sanquin Research, Amsterdam, The Netherlands
| | - Jaap-Jan Zwaginga
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
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2
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Sarıdoğan E, Onat T, Arda Düz S, Tuncay G, Abdurahmanova N, Orujova L, Karaer A. Bernard-Soulier Syndrome from the Perspective of the Obstetrician: A Case Report with a Review of the Literature. Z Geburtshilfe Neonatol 2023. [PMID: 36889343 DOI: 10.1055/a-2024-0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Bernard-Soulier syndrome (BSS) is one of the rare inherited platelet disorders that is characterized by macrothrombocytopenia and adhesion abnormality due to the absence or malfunctioning of the membrane GPIb-IX-V complex. There is no high-quality evidence on obstetric management of BSS owing to its rarity. Here we report an uncomplicated delivery of an adolescent with BSS and review the literature on the topic of BSS and pregnancy. METHODS PUBMED, EMBASE, COCHRANE, and Google Scholar databases were searched up to April 2022 without language and year restriction using the terms "Bernard Soulier" and "Pregnancy". The primary objectives were to evaluate maternal and fetal outcomes. The secondary objectives were to analyze pregnancy complications, gestational age at delivery, mode of delivery, administered prophylaxis, treatment approaches, duration of postpartum hospitalization, and the postpartum requirement of blood and blood product. RESULTS The patient was a 19-year-old and 39-week pregnant woman who was diagnosed with BSS at the age of 10 by flow cytometry and genetic analysis. Single donor platelet transfusions and oral tranexamic acid were administered as prophylaxis at the peripartum period. She was delivered by cesarean section due to failure of labor. The postpartum period was uneventful for both mother and neonate. In the literature review, postpartum hemorrhage (PPH) was found in 52.9% (27/51) of deliveries. Late PPH occurred more frequently than early PPH (35.3 and 31.4%, respectively). 49% (25/51) of pregnancies had severe thrombocytopenia, and antepartum hemorrhage was observed in 11.8% (6/51) of those. The platelet count was in close relation to antenatal complications. 64.7% (33/51) of the patients were delivered via cesarean section. PPH and late PPH were found to be more common in those who delivered vaginally compared to those who delivered by caesarean section. It was observed that PPH was less common in women who were given prophylaxis in the peripartum period. CONCLUSION BSS is an inherited macro-thrombocytopathy that may cause adverse maternal and neonatal outcomes. The optimal mode and timing of delivery remain unclear. A multidisciplinary approach with prophylaxis at the peripartum period should be applied.
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Affiliation(s)
- Erdinç Sarıdoğan
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Taylan Onat
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Senem Arda Düz
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Görkem Tuncay
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Nuray Abdurahmanova
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Lumayat Orujova
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Abdullah Karaer
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
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3
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Igbokwe N, Benson G, Waireri J. Bernard-Soulier syndrome in pregnancy with retinal detachment: a rare phenomenon. BMJ Case Rep 2022; 15:e250405. [PMID: 36129357 PMCID: PMC9438107 DOI: 10.1136/bcr-2022-250405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bernard-Soulier syndrome (BSS) is a rare congenital bleeding disorder of the platelet, and it is mainly inherited as an autosomal recessive trait. It is caused by both qualitative and quantitative deficiency of the platelet membrane glycoprotein (GP) Ib-IX-V receptor complex, thereby causing abnormal platelets adhesion.We report a case of a primigravida in her 20s with history of BSS diagnosed in childhood due to family history. Her preconception period was challenging as she suffered from severe menorrhagia often requiring hospital admission, blood and platelet transfusions.At 35 weeks gestation, she developed temporal crowded retinal detachment of the left eye and had a successful left scleral buckling surgery under general anaesthesia (GA).She had a multidisciplinary team care with a successful elective GA caesarean section at 39+3 weeks gestation with peridelivery platelet transfusion and intravenous recombinant factor VIIa. Regional anaesthesia, intramuscular injections and anticoagulation were avoided.
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Affiliation(s)
- Nnadozie Igbokwe
- Centre for Reproductive Medicine and Surgery, St Bartholomew's Hospital, London, UK
| | - Gary Benson
- Haemophilia and Thrombosis Centre, Belfast City Hospital Health and Social Services Trust, Belfast, UK
| | - Joyce Waireri
- Obstetrics and gynaecology, Royal Jubilee Maternity Service, Belfast, UK
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4
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Karanth L, Abas AB. Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers. Cochrane Database Syst Rev 2021; 12:CD011059. [PMID: 34881425 PMCID: PMC8655611 DOI: 10.1002/14651858.cd011059.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. This is an update of a previously published review. OBJECTIVES To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews. Date of last search of the Group's Trials Registers: 21 June 2021. SELECTION CRITERIA Randomised controlled trials and quasi-randomised controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review. DATA COLLECTION AND ANALYSIS No trials matching the selection criteria were eligible for inclusion. MAIN RESULTS No trials matching the selection criteria were eligible for inclusion. AUTHORS' CONCLUSIONS The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus. Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.
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Affiliation(s)
- Laxminarayan Karanth
- Department of Obstetrics and Gynaecology, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Adinegara Bl Abas
- Department of Community Medicine, Melaka-Manipal Medical College (Manipal Academy of Higher Education), Melaka, Malaysia
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5
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Punt MC, Schuitema PCE, Bloemenkamp KWM, Kremer Hovinga ICL, van Galen KPM. Menstrual and obstetrical bleeding in women with inherited platelet receptor defects-A systematic review. Haemophilia 2020; 26:216-227. [PMID: 32004416 PMCID: PMC7155109 DOI: 10.1111/hae.13927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
Introduction Women with inherited platelet receptor defects (IPRD) may have an increased risk of heavy menstrual bleeding (HMB) and postpartum haemorrhage (PPH). Aim To present a systematic overview of the literature on the prevalence and management of menstrual and obstetrical bleeding in women with IPRD. Methods Electronic databases were searched for original patient data on the prevalence and management of HMB and PPH in women with known IPRD or who were being investigated for IPRD. Results Sixty‐nine papers (61 case reports/series and 8 cohort studies) were included. Overall, studies were rated as ‘poor quality’. The included cohort studies reported HMB in 25% (13/52) of women with Bernard‐Soulier syndrome and in 22.1% (34/154) of women with Glanzmann thrombasthenia. In total, 164 deliveries in women with IPRD were described. Excessive bleeding occurred in 16.9% (11/65) of deliveries described in the largest cohort. PPH occurred in 63.2% (55/87) of deliveries described in case reports/series. PPH occurred in 73.7% (14/19) of deliveries that were not covered by prophylaxis compared with 54.2% (32/59) of deliveries that were (OR = 2.36, 95% CI 0.75‐7.40). Neonatal bleeding complications were reported in 10.0% (8/80) of deliveries. In all (6/6) deliveries with neonatal bleeding complications wherein the presence of alloantibodies was investigated, either antiplatelet or anti‐HLA antibodies were detected. Discussion/Conclusion Menstrual and particularly obstetrical bleeding problems frequently occur in women with IPRD, based on small case reports and series of poor quality. International collaboration, preferably on prospective studies, is needed to improve clinical management of women‐specific bleeding in IPRD.
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Affiliation(s)
- Marieke C Punt
- Van Creveldkliniek, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Pauline C E Schuitema
- Van Creveldkliniek, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Kitty W M Bloemenkamp
- Division Woman and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Idske C L Kremer Hovinga
- Van Creveldkliniek, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Karin P M van Galen
- Van Creveldkliniek, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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6
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7
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Factor VIIa. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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8
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Grainger JD, Thachil J, Will AM. How we treat the platelet glycoprotein defects; Glanzmann thrombasthenia and Bernard Soulier syndrome in children and adults. Br J Haematol 2018; 182:621-632. [DOI: 10.1111/bjh.15409] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- John D. Grainger
- Faculty of Medical & Human Sciences; University of Manchester; England UK
- Department of Paediatric Haematology; Royal Manchester Children's Hospital; Manchester University NHS Foundation Trust; Manchester UK
| | - Jecko Thachil
- Department of Haematology; Manchester Royal Infirmary; Manchester University NHS Foundation Trust; Manchester UK
| | - Andrew M. Will
- Department of Paediatric Haematology; Royal Manchester Children's Hospital; Manchester University NHS Foundation Trust; Manchester UK
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9
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Karanth L, Kanagasabai S, Abas ABL. Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers. Cochrane Database Syst Rev 2017; 8:CD011059. [PMID: 28776324 PMCID: PMC6483261 DOI: 10.1002/14651858.cd011059.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. This is an update of a previously published review. OBJECTIVES To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews.Date of last search of the Group's Trials Registers: 16 February 2017. SELECTION CRITERIA Randomised controlled trials and all types of controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review. DATA COLLECTION AND ANALYSIS No trials matching the selection criteria were eligible for inclusion MAIN RESULTS: No results from randomised controlled trials were found. AUTHORS' CONCLUSIONS The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.
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Affiliation(s)
- Laxminarayan Karanth
- Melaka Manipal Medical CollegeDepartment of Obstetrics and GynecologyBukit Baru, Jalan BatuHamparMelakaMalaysia75150
| | - Sachchithanantham Kanagasabai
- Melaka Manipal Medical CollegeDepartment of Obstetrics and GynecologyBukit Baru, Jalan BatuHamparMelakaMalaysia75150
| | - Adinegara BL Abas
- Melaka‐Manipal Medical CollegeDepartment of Community MedicineJalan Batu HamparBukit BaruMelakaMalaysia75150
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10
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Curtis BR. Recent progress in understanding the pathogenesis of fetal and neonatal alloimmune thrombocytopenia. Br J Haematol 2015; 171:671-82. [PMID: 26344048 DOI: 10.1111/bjh.13639] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs in c. 1 in 1000 births and is caused by maternal antibodies against human platelet alloantigens that bind incompatible fetal platelets and promote their clearance from the circulation. Affected infants can experience bleeding, bruising and, in severe cases, intracranial haemorrhage and even death. As maternal screening is not routinely performed, and first pregnancies can be affected, most cases are diagnosed at delivery of a first affected pregnancy. Unlike its erythrocyte counterpart, Haemolytic Disease of the Fetus and Newborn, there is no prophylactic treatment for FNAIT. This report will review recent advances made in understanding the pathogenesis of FNAIT: the platelet alloantigens involved, maternal exposure and sensitization to fetal platelet antigens, properties of platelet Immunoglobulin G antibodies, maternal-fetal antibody transport mechanisms and efforts to develop an effective FNAIT prophylaxis.
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Affiliation(s)
- Brian R Curtis
- Platelet & Neutrophil Immunology Laboratory and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
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11
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Karanth L, Kanagasabai S, Abas ABL. Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers. Cochrane Database Syst Rev 2015:CD011059. [PMID: 25835707 DOI: 10.1002/14651858.cd011059.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. OBJECTIVES To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews.Date of last search of the Group's Trials Registers: 13 January 2015. SELECTION CRITERIA Randomised controlled trials and all types of controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review. DATA COLLECTION AND ANALYSIS No trials matching the selection criteria were eligible for inclusion MAIN RESULTS No results from randomized controlled trials were found. AUTHORS' CONCLUSIONS The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.
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Affiliation(s)
- Laxminarayan Karanth
- Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Bukit Baru, Jalan Batu, Hampar, Melaka, Malaysia, 75150
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12
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Noris P, Schlegel N, Klersy C, Heller PG, Civaschi E, Pujol-Moix N, Fabris F, Favier R, Gresele P, Latger-Cannard V, Cuker A, Nurden P, Greinacher A, Cattaneo M, De Candia E, Pecci A, Hurtaud-Roux MF, Glembotsky AC, Muñiz-Diaz E, Randi ML, Trillot N, Bury L, Lecompte T, Marconi C, Savoia A, Balduini CL, Bayart S, Bauters A, Benabdallah-Guedira S, Boehlen F, Borg JY, Bottega R, Bussel J, De Rocco D, de Maistre E, Faleschini M, Falcinelli E, Ferrari S, Ferster A, Fierro T, Fleury D, Fontana P, James C, Lanza F, Le Cam Duchez V, Loffredo G, Magini P, Martin-Coignard D, Menard F, Mercier S, Mezzasoma A, Minuz P, Nichele I, Notarangelo LD, Pippucci T, Podda GM, Pouymayou C, Rigouzzo A, Royer B, Sie P, Siguret V, Trichet C, Tucci A, Saposnik B, Veneri D. Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Haematologica 2014; 99:1387-94. [PMID: 24763399 DOI: 10.3324/haematol.2014.105924] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L.
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Affiliation(s)
- Patrizia Noris
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Nicole Schlegel
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Catherine Klersy
- Service of Biometry and Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paula G Heller
- Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina
| | - Elisa Civaschi
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Nuria Pujol-Moix
- Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica Sant Pau, Spain
| | - Fabrizio Fabris
- Department of Medicine-DIMED, University of Padova Medical School, Italy
| | - Remi Favier
- AP-HP, Armand Trousseau Children's Hospital, Haematological Laboratory, French Reference Center for Inherited Platelet disorders, Paris, France Inserm UMR1009, Villejuif, France
| | - Paolo Gresele
- Department of Internal Medicine, University of Perugia, Italy
| | - Véronique Latger-Cannard
- Centre de Compétence Nord-Est des Pathologies Plaquettaires from the frame of the Reference French Centre, France Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paquita Nurden
- Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
| | | | - Marco Cattaneo
- Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Erica De Candia
- Servizio Malattie Emorragiche e Trombotiche, Istituto di Medicina Interna e Geriatria, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Marie-Françoise Hurtaud-Roux
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Ana C Glembotsky
- Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina
| | - Eduardo Muñiz-Diaz
- Immunohematology Department, Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | - Maria Luigia Randi
- Department of Medicine-DIMED, University of Padova Medical School, Italy
| | - Nathalie Trillot
- Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU, Lille, France
| | - Loredana Bury
- Department of Internal Medicine, University of Perugia, Italy
| | - Thomas Lecompte
- Département des Spécialités de Médecine, Service d'Hématologie, Hôpitaux Universitaires de Genève, Suisse Université de Genève, Faculté de Médecine, Suisse
| | - Caterina Marconi
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi, University of Bologna, Italy
| | - Anna Savoia
- Department of Medical Sciences, University of Trieste, Italy Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Sophie Bayart
- Service d'Hémostase Bio-Clinique, Centre Régional de traitement des maladies hémorragiques de Rennes-Bretagne, CHU de Rennes, Rennes, France
| | - Anne Bauters
- Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU Lille, France
| | | | - Françoise Boehlen
- Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Roberta Bottega
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - James Bussel
- Weill Medical College of Cornell University, New York, NY, USA
| | - Daniela De Rocco
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Emmanuel de Maistre
- Service d'hématologie Biologie, Centre Hospitalo-Universitaire Dijon, France
| | | | | | - Silvia Ferrari
- Department of Medicine-DIMED; University of Padova Medical School, Padova, Italy
| | - Alina Ferster
- Unité d'Hémato-Oncologie pédiatrique, Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgique
| | - Tiziana Fierro
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - Pierre Fontana
- Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Chloé James
- Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU Haut Lévêque, Pessac, France
| | | | | | - Giuseppe Loffredo
- Department of Oncology, Azienda Santobono-Pausilipon, Pausilipon Hospital, Napoli, Italy
| | - Pamela Magini
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy
| | | | - Fanny Menard
- Centre Hospitalier de la côte basque, Bayonne, France
| | - Sandra Mercier
- Service de Génétique Clinique, Centre de Référence Anomalies du Développement du Grand Ouest, CHU Rennes-Hôpital Sud, Rennes, France
| | | | - Pietro Minuz
- Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy
| | - Ilaria Nichele
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | | | - Tommaso Pippucci
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy
| | - Gian Marco Podda
- Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Catherine Pouymayou
- Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU La Timone, Marseille, France
| | - Agnes Rigouzzo
- AP-HP, Armand Trousseau children Hospital, Department of Anesthesiology, Paris, France
| | - Bruno Royer
- Hématologie clinique et thérapie cellulaire, CHU Amiens, France
| | - Pierre Sie
- Laboratoire d'Hématologie and National Reference Centre of Inherited Platelet Disorders, CHU Rangueil, Toulouse, France
| | - Virginie Siguret
- Service d' Hématologie Biologique, CHU Hôpital Européen Georges Pompidou, Paris, France
| | - Catherine Trichet
- Service de Biologie Clinique Secteur Hématologie, CH Victor Dupouy, Argenteuil, France
| | - Alessandra Tucci
- Hematology Unit, Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | - Béatrice Saposnik
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Dino Veneri
- Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy
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Thongrong C, Kasemsiri P, Hofmann JP, Bergese SD, Papadimos TJ, Gracias VH, Adolph MD, Stawicki SPA. Amniotic fluid embolism. Int J Crit Illn Inj Sci 2013; 3:51-7. [PMID: 23724386 PMCID: PMC3665120 DOI: 10.4103/2229-5151.109422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations. Special attention is paid to the modern aggressive supportive care that resulted in an overall reduction in the still alarmingly high mortality rate of this devastating entity. The key factors for successful management and resolution of this disease process continue to be sharp vigilance, a high level of clinical suspicion, and rapid all-out resuscitative efforts on the part of all clinicians involved in the medical care of the parturient.
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Affiliation(s)
- Cattleya Thongrong
- Department of Anesthesiology, Division of Trauma, Critical Care and Burn, The Ohio State University College of Medicine, Columbus, USA ; Department of Anesthesiology, Srinagarind Hospital, Faculty of Medicine at the Khon Kaen University, Khon Kaen, Thailand
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14
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Li C, Piran S, Chen P, Lang S, Zarpellon A, Jin JW, Zhu G, Reheman A, van der Wal DE, Simpson EK, Ni R, Gross PL, Ware J, Ruggeri ZM, Freedman J, Ni H. The maternal immune response to fetal platelet GPIbα causes frequent miscarriage in mice that can be prevented by intravenous IgG and anti-FcRn therapies. J Clin Invest 2011; 121:4537-47. [PMID: 22019589 PMCID: PMC3204841 DOI: 10.1172/jci57850] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 08/26/2011] [Indexed: 11/17/2022] Open
Abstract
Fetal and neonatal immune thrombocytopenia (FNIT) is a severe bleeding disorder caused by maternal antibody-mediated destruction of fetal/neonatal platelets. It is the most common cause of severe thrombocytopenia in neonates, but the frequency of FNIT-related miscarriage is unknown, and the mechanism(s) underlying fetal mortality have not been explored. Furthermore, although platelet αIIbβ3 integrin and GPIbα are the major antibody targets in immune thrombocytopenia, the reported incidence of anti-GPIbα-mediated FNIT is rare. Here, we developed mouse models of FNIT mediated by antibodies specific for GPIbα and β3 integrin and compared their pathogenesis. We found, unexpectedly, that miscarriage occurred in the majority of pregnancies in our model of anti-GPIbα-mediated FNIT, which was far more frequent than in anti-β3-mediated FNIT. Dams with anti-GPIbα antibodies exhibited extensive fibrin deposition and apoptosis/necrosis in their placentas, which severely impaired placental function. Furthermore, anti-GPIbα (but not anti-β3) antiserum activated platelets and enhanced fibrin formation in vitro and thrombus formation in vivo. Importantly, treatment with either intravenous IgG or a monoclonal antibody specific for the neonatal Fc receptor efficiently prevented anti-GPIbα-mediated FNIT. Thus, the maternal immune response to fetal GPIbα causes what we believe to be a previously unidentified, nonclassical FNIT (i.e., spontaneous miscarriage but not neonatal bleeding) in mice. These results suggest that a similar pathology may have masked the severity and frequency of human anti-GPIbα-mediated FNIT, but also point to possible therapeutic interventions.
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MESH Headings
- Abortion, Spontaneous/etiology
- Abortion, Spontaneous/immunology
- Abortion, Spontaneous/prevention & control
- Animals
- Blood Platelets/immunology
- Disease Models, Animal
- Female
- Histocompatibility Antigens Class I/immunology
- Histocompatibility, Maternal-Fetal/immunology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Integrin beta3/genetics
- Integrin beta3/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Platelet Glycoprotein GPIb-IX Complex/genetics
- Platelet Glycoprotein GPIb-IX Complex/immunology
- Pregnancy
- Receptors, Fc/antagonists & inhibitors
- Receptors, Fc/immunology
- Thrombocytopenia, Neonatal Alloimmune/etiology
- Thrombocytopenia, Neonatal Alloimmune/immunology
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Affiliation(s)
- Conglei Li
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Siavash Piran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Pingguo Chen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Sean Lang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Alessandro Zarpellon
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Joseph W. Jin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Guangheng Zhu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Adili Reheman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Dianne E. van der Wal
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Elisa K. Simpson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Ran Ni
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Peter L. Gross
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Jerry Ware
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Zaverio M. Ruggeri
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - John Freedman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
| | - Heyu Ni
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Toronto Platelet Immunobiology Group and Department of Laboratory Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada.
Canadian Blood Services, Toronto, Ontario, Canada.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Medicine and
Department of Physiology, University of Toronto, Ontario, Canada
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15
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Valera MC, Parant O, Vayssiere C, Arnal JF, Payrastre B. Physiologic and pathologic changes of platelets in pregnancy. Platelets 2010; 21:587-95. [PMID: 20873962 DOI: 10.3109/09537104.2010.509828] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Platelets are key players in haemostasis and thrombus formation. Defects affecting platelets during pregnancy can lead to heterogeneous complications, such as thrombosis, first trimester miscarriage and postpartum haemorrhage. The incidence of complications is increased in women who have heritable platelet function disorders. Modifications of platelet count or platelet functions during normal pregnancy and preeclampsia will be summarized and the management of pregnant women with heritable platelet function disorders will be discussed.
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Affiliation(s)
- Marie-Cecile Valera
- INSERM U858, I2MR, Equipe 9, CHU Rangueil, BP 84225, 31432 Toulouse cedex 4, France
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16
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17
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Peitsidis P, Datta T, Pafilis I, Otomewo O, Tuddenham EGD, Kadir RA. Bernard Soulier syndrome in pregnancy: a systematic review. Haemophilia 2010; 16:584-91. [PMID: 20070385 DOI: 10.1111/j.1365-2516.2009.02137.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder.
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Affiliation(s)
- P Peitsidis
- Royal Free Hospital, Obstetrics and Gynaecology, London, UK
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18
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Abstract
Amniotic fluid embolism is one of the most catastrophic complications of pregnancy. First described in 1941, the condition is exceedingly rare and the exact pathophysiology is still unknown. The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis. Common presenting symptoms include dyspnea, nonreassuring fetal status, hypotension, seizures, and disseminated intravascular coagulation. Early recognition of amniotic fluid embolism is critical to a successful outcome. However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother. Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.
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Affiliation(s)
- Richard S Gist
- Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L Levy Place, New York City, NY 10029-6574, USA
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19
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Abstract
Bernard-Soulier syndrome (BSS) is a rare autosomal recessively inherited bleeding disorder. Pregnancy in patients with BSS is characterized by ante-, intra-, or postpartum haemorrhage, which may be delayed and severe. There is no consensus in the management of BSS in pregnancy and so far only 16 pregnancies in nine patients have been described. We report a further three pregnancies in two women with the syndrome. We also outline our management of pregnant patients with BSS.
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Affiliation(s)
- P Prabu
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK
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20
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Kriplani A, Singh BM, Sowbernika R, Choudhry VP. Successful pregnancy outcome in Bernard-Soulier syndrome. J Obstet Gynaecol Res 2005; 31:52-6. [PMID: 15669993 DOI: 10.1111/j.1447-0756.2005.00240.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bernard-Soulier syndrome is a rare bleeding disorder, and there is scant literature on the pregnancy outcome in women with this syndrome. Due to the bleeding tendency in this disease, pregnant woman may have ante-, intra- or postpartum complications. We report our experience of managing a pregnant woman with Bernard-Soulier syndrome who had a successful pregnancy outcome, and review the existing literature on pregnancy in women with this syndrome.
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Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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21
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McCarty OJT, Jadhav S, Burdick MM, Bell WR, Konstantopoulos K. Fluid shear regulates the kinetics and molecular mechanisms of activation-dependent platelet binding to colon carcinoma cells. Biophys J 2002; 83:836-48. [PMID: 12124268 PMCID: PMC1302190 DOI: 10.1016/s0006-3495(02)75212-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was undertaken to investigate the kinetics and molecular requirements of platelet binding to tumor cells in bulk suspensions subjected to a uniform linear shear field, using a human colon adenocarcinoma cell line (LS174T) as a model. The effects of shear rate (20-1000 s(-1)), shear exposure time (30-300 s), shear stress (at constant shear rate by adjusting the viscosity of the medium from 1.3-2.6 cP), cell concentration, and platelet activation on platelet-LS174T heteroaggregation were assessed. The results indicate that hydrodynamic shear-induced collisions augment platelet-LS174T binding, which is further potentiated by thrombin/GPRP-NH(2). Peak adhesion efficiency occurs at low shear and decreases with increasing shear. Intercellular contact duration is the predominant factor limiting heteroaggregation at shear rates up to 200 s(-1), whereas these interactions become shear stress-sensitive at > or = 400 s(-1). Heteroaggregation increases with platelet concentration due to an elevation of the intercellular collision frequency, whereas adhesion efficiency remains nearly constant. Moreover, hydrodynamic shear affects the receptor specificity of activation-dependent platelet binding to LS174T cells, as evidenced by the transition from a P-selectin-independent/Arg-Gly-Asp (RGD)-dependent process at 100 s(-1) to a P-selectin/alpha(IIb)beta(3)-dependent interaction at 800 s(-1). This study demonstrates that platelet activation and a fluid-mechanical environment representative of the vasculature affect platelet-tumor cell adhesive interactions pertinent to the process of blood-borne metastasis.
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Affiliation(s)
- Owen J T McCarty
- Department of Chemical Engineering, Johns Hopkins University, Baltimore, Maryland 21218 USA
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23
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24
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