What are the ASH recommendations for the treatment of immune thrombocytopenic purpura (ITP) during delivery?

Updated: Jun 28, 2019
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

ASH recommendations are as follows:

  • Because of the possible need for cesarean delivery, the recommended target platelet count prior to labor and delivery is ≥50 x 10 9/L
  • A woman whose platelet count is < 80 x 10 9/L but who has not required therapy during pregnancy can be started on oral prednisone (or prednisolone) 10 days prior to anticipated delivery at a dose of 10-20 mg daily and titrated as necessary
  • The mode of delivery should be determined by obstetric indications
  • Although the minimum platelet count for the placement of regional anesthesia is unknown and local practices may differ, many anesthesiologists will place a regional anesthetic if the platelet count is ≥80 x 10 9/L
  • While platelet transfusion alone is generally not effective in ITP, its use in conjunction with IVIg can be considered if an adequate platelet count has not been achieved and delivery is emergent
  • Percutaneous umbilical blood sampling (PUBS) or fetal scalp blood sampling is not recommended, as it is not helpful in predicting neonatal thrombocytopenia and is potentially harmful
  • In the newborn, the nadir platelet count reaches its nadir 2-5 days after delivery and rises spontaneously by day 7
  • Postpartum thromboprophylaxis should be considered, as women with ITP are at increased risk of venous thromboembolism

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