Аннотация
В статье представлены основные клинические ситуации с наличием тромбоцитопении у беременных. Приводятся диагностические критерии наиболее частых заболеваний с наличием тромбоцитопении, возникающих в гестационном периоде. Обсуждаются вопросы дифференциальной диагностики тромбоцитопений у беременных.
Ключевые слова: беременность, тромбоцитопения, тромботические микроангиопатии, гестационная тромбоцитопения, иммунная тромбоцитопения.
Об авторе
Л.И. Дворецкий
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
dvoretski@mail.ru
Список литературы
1. Cheng CK, Chan J, Cembrowski GS, van Assendelft OW. Complete blood count reference interval diagrams derived from NHANES III: stratification by age, sex, and race. Lab Hematol 2004; 10 (1): 42–53. DOI: 10.1532/lh96.04010
2. Boehlen F, Hohlfeld P, Extermann P et al. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 2000; 95 (1): 29–33. DOI: 10.1016/s0029-7844(99)00537-2
3. Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy. Proceed Obstet Gynecol 2013; 3: 6.
4. Reese JA, Peck JD, Deschamps DR et al. Platelet counts during pregnancy. N Engl J Med 2018; 379: 32–43. DOI: 10.1056/NEJMoa 1802897
5. Valera MC, Parant O, Vayssiere C et al. Physiologic and pathologic changes of platelets in pregnancy. Platelets 2010; 21: 587–95. DOI: 10.3109/09537104.2010.509828
6. Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood 2017; 130: 2271–7. DOI: 10.1182/blood-2017-05-781971
7. Bockenstedt PL. Thrombocytopenia in pregnancy. Hematol Oncol Clin North Am 2011; 25 (2): 293–310. DOI: 10.1016/j.hoc.2011.01.004
8. Reese JA, Peck JD, McIntosh JJ et al. Platelet counts in women with normal pregnancies: A systematic review. Am J Hematol 2017; 92 (11): 1224–32. DOI: 10.1002/ajh.24829. PMID: 28631317.
9. Kasai J, Aoki S, Kamiya N et al. Clinical features of gestational thrombocytopenia difficult to differentiate from immune thrombocytopenia diagnosed during pregnancy. J Obstet Gynaecol Res 2015; 41: 44–9. DOI:10.1111/jog.12496
10. Rottenstreich A, Israeli N, Levin G et al. Clinical characteristics, neonatal risk and recurrence rate of gestational thrombocytopenia with platelet count <100×109/L. Eur J Obstet Gynecol Reprod Biol 2018; 231: 75–9. DOI: 10.1016/j.ejogrb.2018.10.026
11. Kohli S, Ranjan S, Hoffmann J et al. Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts. Blood 2016; 12 (17): 2153–64. DOI: 10.1182/blood2016-03-705434
12. Gestational hypertension and preeclampsia ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol 2020; 135 (6): 1492–5. DOI: 10.1097/aog.0000000000003892
13. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood 2013; 121: 38–47.
14. Myers B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol 2012; 158: 3–15. DOI: 10.1111/j.1365- 2141.2012.09135.x
15. Mol BWJ, Roberts CT, Thangaratinam S et al. Pre-eclampsia. Lancet 2016; 387: 999–1011. DOI: 10.1016/S0140-6736(15)00070-7
16. Martin JN, Rinehart BK, May WL et al. the spectrum of severe preeclampsia: comparative analysis by HELLP syndrome classification. Am J Obstet Gynecol 1999; 180: 1373–84. DOI: 10.1016/s0002- 9378(99)70022-0
17. Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol 2014; 123: 618–27. DOI: 10.1097/AOG. 0000000000000140
18. Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med 2000; 28: 249–60. DOI: 10.1515/JPM.2000.033
19. Phipps E, Prasanna D, Brima W, Jim B. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Nephrol 2016; 11: 1102–13. DOI: 10.2215/CJN.12081115
20. Lee NM, Brady CW. Liver disease in pregnancy. World J Gastroenterol 2009; 15 (8): 897–906. DOI: 10.3748/wjg.15.897
21. Ding J, Han LP, Lou XP et al. Effectiveness of combining plasma exchange with plasma perfusion in acute fatty liver of pregnancy: a retrospective analysis. Gynecol Obstet Invest 2015; 79: 97–100. DOI: 10.1159/000368752
22. Макацария А.Д., Панфилова О.Ю. К вопросу о ДВС-синдроме в акушерстве: новое о старом. Практическая медицина. 2010; 4 (43): 25. [Makatsariia A.D., Panfilova O.Iu. K voprosu o DVS-sindrome v akusherstve: novoe o starom. Prakticheskaia meditsina. 2010; 4 (43): 25 (in Russian).]
23. Mariotte E, Azoulay E, Galicier L et al. Epidemiology and pathophysiology of adulthood-onset thrombotic microangiopathy with severe ADAMTS13 deficiency (thrombotic thrombo-cytopenic purpura): a cross-sectional analysis of the French national registry for thrombotic microangiopathy. Lancet Haematol 2016; 3: e237–45. DOI: 10.1016/S2352-3026(16)30018-7
24. Von Auer C, von Krogh AS, Kremer Hovinga JA, Lämmle B. Current insights into thrombotic microangiopathies: Thrombotic thrombocytopenic purpura and pregnancy. Thromb Res 2015; 135 (Suppl. 1): 30–3. DOI: 10.1016/S0049-3848(15)50437-4
25. Kappler S, Ronan-Bentle S, Graham A. Thrombotic microangiopathies (TTP, HUS, HELLP). Emerg Med Clin N Am 2014; 32: 649–71. DOI: 10.1016/j.emc.2014.04.008
26. George JN, Nester CM. Syndrome of thrombotic microangiopathy. N Engl J Med 2014; 371: 654–66. DOI: 10.1056/NEJMra1312353
27. Bergmann F, Rath W. The Differential Diagnosis of Thrombocytopenia in Pregnancy. An interdisciplinary challenge. Dtsch Arztebl Int 2015; 112 (47): 795–802. DOI: 10.3238/arztebl.2015.0795
28. Keiser SD, Boyd KW, Rehberg JF et al. A high LDH to AST ratio helps to differentiate pregnancy-associated thrombotic thrombocytopenic purpura (TTP) from HELLP syndrome. J Matern-Fetal Neonatal Med 2012; 25: 1059–63. DOI: 10.3109/14767058.2011.619603
29. Jokiranta TS. HUS and atypical HUS. Blood 2017; 129: 2847–56. DOI: 10.1182/blood-2016-11-709865
30. Thomas MR, Robinson S, Scully MA. How we manage thrombotic microangiopathies in pregnancy. Br J Haematol 2016; 173: 821–30. DOI: 10.1111/bjh.14045
31. Legendre C.M., Licht C., Muus P. et al. Terminal complement inhibitor ecuzulimab in atypical hemolytic-uremic syndrome. N Engl J Med. 2013;368:2169–2181 DOI: 10.1056/NEJMoa1208981
32. Sarno L, Tufano A, Maruotti GM et al. Eculizumab in pregnancy: a narrative overview. J Nephrol 2019; 32: 17–25. DOI: 10.1007/s40620-018- 0517-z
33. Park YH. Diagnosis and management of thrombocytopenia in pregnancy. Blood Res 2022; 57 (S1): 79–85. DOI: 10.5045/br.2022. 2022068. PMID: 35483931; PMCID: PMC9057658
34. Care A, Pavord S, Knight M, Alfirevic Z. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. BJOG 2018; 125 (5): 604–12. DOI: 10.1111/1471-0528.14697. PMID: 28432736
35. Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Hematol 2000; 37 (3): 275–89. DOI: 10.1016/s0037-1963(00)90106-9
36. Антифосфолипидный синдром. Под ред. Е.Л. Насонова. М.: Литтера, 2004. [Antifosfolipidnyi sindrom. Pod red. E.L. Nasonova. M.: Littera, 2004 (in Russian).]
37. Miyakis S, Lockshin M, Atsumi T et al. International consensus statement on an update of the classifi cation criteria for defi nite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295–306. DOI: 10.1111/j.1538-7836.2006.01753.x
38. Fayyaz A,Igoe A, Kurien B et al. Haematological manifestations of lupus. Lupus Sci Med 2015; 2: e000078. DOI: 10.1136/lupus-2014-000078
39. Bashal F. Hematological disorders in patients with systemic lupus erythematosus. Open Rheumatol J 2013; 7: 87–95. DOI: 10.2174/ 18743129013 07010087
40. Hepburn AL, Narat S, Mason JC. The management of peripheral blood cytopenias in systemic lupus erythematosus. Rheumatology 2010; 49 (12): 2243–54. DOI: 10.1093/rheumatology/keq269
41. Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008; 199 (2): 127. e1–6. DOI: 10.1016/j.ajog.2008.03.012
42. Zhao C, Zhao J, Huang Y et al. New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol 2013; 32 (6): 815–22. DOI: 10.1007/s10067-013-2180-z. PMID: 23358829
43. He X, Jiang D, Wang Z et al. Clinical features of new-onset systemic lupus erythematosus during pregnancy in Central China: a retrospective study of 68 pregnancies. Clin Rheumatol 2021; 40 (6): 2121– 31. DOI: 10.1007/s10067-020-05452-2. PMID: 33064224.
Для цитирования:Дворецкий Л.И. У беременной тромбоцитопения. Клинический разбор в общей медицине. 2023; 4 (3): 15–21. DOI: 10.47407/kr2023.4.3.00217
Журнал предоставляет свободный доступ с возможностью использовать статьи в некоммерческих целях при условии указания авторства в рамках лицензии CC BY-NC-SA 4.0 (https://creativecommons.org/licenses/by-nc-sa/4.0/deed.ru)