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thrombocytopenia in pregnancy

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https://www.readbyqxmd.com/read/27908907/importance-of-diagnostic-work-up-of-guillain-barr%C3%A3-syndrome-in-pregnancy
#1
Elza Pollak-Christian, Kyong-Soon Lee
We report a full-term neonate presenting with symptomatic congenital cytomegalovirus (CMV) infection with hepatosplenomegaly, 'blueberry muffin' rash, intracranial calcifications, thrombocytopenia and respiratory distress. Maternal history was relevant for Guillain-Barré syndrome (GBS) during the first trimester of pregnancy. CMV infection is an important cause of GBS; thus, women presenting GBS during pregnancy should be screened for CMV infection. If positive, they may benefit from specialised monitoring and treatment in the antenatal period, which may decrease the risk of major neurodevelopmental sequelae of congenital CMV in the neonate...
December 1, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27882754/-fetal-alloimmune-thrombocytopenia-in-pregnant-woman-with-anti-hpa-1a-antibodies
#2
K Sobíšková, J Matěcha
OBJECT: Description of the pregnancy in patient with anti-HPA-1a antibodies. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital. CASE REPORT: Report of cases of neonatal alloimune thrombocytopenia in a patient with proven anti-HPA 1a antibodies. The immunization developed during the first pregnancy, accompanied with fetal thrombocytopenia which recurred in every subsequent pregnancy with greater severity...
2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27882749/-severe-immune-thrombocytopenia-diagnosed-in-pregnancy
#3
K Bláhová
OBJECTIVE: The aim of this article is present a patient with severe immune thrombocytopenia in pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine, Palacký Univerzity Olomouc. CASE REPORT: Presents a patient with immune thrombocytopenia diagnosed in pregnancy. Severe thrombocytopenia was diagnosed incidentally. CONCLUSION: Severe immune thrombocytopenia is rare and substantial complication in pregnancy...
2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27871460/placental-histological-lesions-in-fetal-and-neonatal-alloimmune-thrombocytopenia-a-retrospective-cohort-study-of-21-cases
#4
Estelle Dubruc, Frédérique Lebreton, Catherine Giannoli, Muriel Rabilloud, Cyril Huissoud, Mojgan Devouassoux-Shisheboran, Fabienne Allias
BACKGROUND: Alloimmunization against human platelet antigens (HPAs) can occur prenatally and induce fetal/neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to identify placental histological features associated with platelet alloimmunization and their clinical significance. METHODS: This study examined 21 placentas from FNAIT-affected pregnancies and 42 age-matched control cases, all collected from pathology departments in the Rhône-Alpes region...
December 2016: Placenta
https://www.readbyqxmd.com/read/27868334/consensus-on-the-standardization-of-terminology-in-thrombotic-thrombocytopenic-purpura-and-related-thrombotic-microangiopathies
#5
M Scully, S Cataland, P Coppo, J de la Rubia, K D Friedman, J Kremer Hovinga, B Lämmle, M Matsumoto, K Pavenski, E Sadler, R Sarode, H Wu
BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are two important acute conditions to diagnose. Thrombotic Microangiopathy is a broad pathophysiological process that leads to microangiopathic hemolytic anemia, thrombocytopenia and involves capillary and small vessel platelet aggregates. The most common cause being disseminated intravascular coagulation (DIC), which may be differentiated by abnormal coagulation. Clinically, a number of conditions present with microangiopathic hemolytic anemia and thrombocytopenia (MAHAT), including cancer, infection, transplantation, drugs, autoimmune disease and pre-eclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome in pregnancy...
November 21, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27852374/-clinical-features-and-adverse-pregnancy-outcomes-of-new-onset-systemic-lupus-erythematosus-during-pregnancy
#6
Z P Zhan, Y Yang, Y F Zhan, D Y Chen, L Q Liang, X Y Yang
Objective: To investigate the clinical characteristics and adverse pregnancy outcomes in pregnant women with new onset systemic lupus erythematosus (SLE) during pregnancy. Methods: The clinical data of 263 pregnancies with SLE in the First Affiliated Hospital of Zhongshan University from 2001 to 2015 were collected and analyzed retrospectively. Results: Of all the 263 pregnancies, 188 were diagnosed before pregnancy and 75 were newly diagnosed during pregnancy. Among the 75 new onset SLE, 27, 31, 14 and 3 cases were diagnosed during first trimester, second trimester, third trimester and puerperium, respectively...
November 8, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27848915/heparin-monitoring-clinical-outcome-and-practical-approach
#7
Noémie Despas, Anne-Sophie Larock, Hugues Jacqmin, Jonathan Douxfils, Bernard Chatelain, Marc Chatelain, François Mullier
Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate...
December 1, 2016: Annales de Biologie Clinique
https://www.readbyqxmd.com/read/27832051/incidence-of-zika-virus-disease-by-age-and-sex-puerto-rico-november-1-2015-october-20-2016
#8
Matthew Lozier, Laura Adams, Mitchelle Flores Febo, Jomil Torres-Aponte, Melissa Bello-Pagan, Kyle R Ryff, Jorge Munoz-Jordan, Myriam Garcia, Aidsa Rivera, Jennifer S Read, Stephen H Waterman, Tyler M Sharp, Brenda Rivera-Garcia
Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes; symptoms of infection include rash, arthralgia, fever, and conjunctivitis.*(,)(†) Zika virus infection during pregnancy can cause microcephaly and other serious brain anomalies (1), and in rare cases, Zika virus infection has been associated with Guillain-Barré syndrome (2) and severe thrombocytopenia (3). This report describes the incidence of reported symptomatic Zika virus disease in the U.S. territory of Puerto Rico by age and sex...
November 11, 2016: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/27829878/glanzmann-thrombasthenia-in-pregnancy-optimising-maternal-and-fetal-outcomes
#9
A Wijemanne, I Watt-Coote, S Austin
Glanzmann thrombasthenia is a rare autosomal recessive haemorrhagic disorder. The risks of miscarriage, antepartum and postpartum haemorrhage, and neonatal complications are all increased in individuals presenting with the disease in pregnancy. Some individuals may develop antibodies to platelet glycoproteins; the presence of these antibodies is a rare cause of neonatal alloimmune thrombocytopenia and potential intracranial haemorrhage. Multidisciplinary care is paramount for ensuring optimal fetal and maternal outcomes in such cases...
December 2016: Obstetric Medicine
https://www.readbyqxmd.com/read/27824770/microangiopathic-hemolytic-anemia-due-to-malignancy-in-pregnancy
#10
Sarah K Happe, Amanda C Zofkie, David B Nelson
BACKGROUND: Microangiopathic disorders during pregnancy remain a diagnostic challenge because these conditions often imitate more common obstetric diseases. CASE: A 31-year-old multigravid woman delivered at term with a postpartum course complicated by laboratory indices consistent with hemolysis, elevated liver enzymes, and low platelet count syndrome. After clinical recovery, she was readmitted 2 weeks after delivery with presumptive pyelonephritis. Persistent hemolysis and worsening thrombocytopenia suggested a diagnosis of thrombotic microangiopathy, which did not respond to plasma exchange...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27806668/contemporary-management-of-neonatal-alloimmune-thrombocytopenia-good-outcomes-in-the-intravenous-immunoglobulin-era-results-from-the-australian-neonatal-alloimmune-thrombocytopenia-registry
#11
Gemma L Crighton, Ri Scarborough, Zoe K McQuilten, Louise E Phillips, Helen F Savoia, Bronwyn Williams, Rhonda Holdsworth, Amanda Henry, Erica M Wood, Stephen A Cole
OBJECTIVE: To describe the natural history, antenatal and postnatal therapy, and clinical outcomes of Australian patients with fetomaternal/neonatal alloimmune thrombocytopenia (NAIT) recorded in the Australian NAIT Registry. METHODS: Analysis of registry data of Australian mothers treated antenatally for NAIT and any fetus/newborn with thrombocytopenia (TCP) and maternal human platelet antigen (HPA) antibodies. RESULTS: 94 potential cases (91 pregnancies; three twin pregnancies) were registered between December 2004 and September 2015 with 76 confirmed or treated as NAIT...
November 2, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27802832/reproductive-issues-in-patients-undergoing-hematopoietic-stem-cell-transplantation-an-update
#12
REVIEW
Maurizio Guida, Maria Antonietta Castaldi, Rosa Rosamilio, Valentina Giudice, Francesco Orio, Carmine Selleri
In 1963 George Mathé announced to the world that he had cured a patient of leukaemia by means of a bone-marrow transplant. Since than much progress has been made and nowadays Hematopoietic Stem Cell Transplantation (HSCT) is considered the most effective treatment of numerous severe haematological diseases. Gynaecological complications in HSCT women represent a serious concern for these patients, but often underestimated by clinicians in the view of Overall Survival. The main gynaecological complications of HSCT are represented by: premature ovarian failure (POF), thrombocytopenia-associated menorrhagia, genital symptoms or sexual problems in course of chronic GVHD (cGVHD), osteoporosis, secondary solid tumours due to immunosuppressive drugs to treat cGVHD and severity of cGVHD, and fertility and pregnancy issues...
November 1, 2016: Journal of Ovarian Research
https://www.readbyqxmd.com/read/27768015/hemolytic-uremic-syndrome-in-children
#13
Valentina Talarico, Monica Aloe, Alice Monzani, Roberto Miniero, Gianni Bona
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy defined by thrombocytopenia, non-immune microangiopathic hemolytic anemia and acute renal failure. HUS is typically classified into two primary types: 1) HUS due to infections, often associated with diarrhea (D+HUS, Shiga toxin-producing Escherichia Coli-HUS), with the rare exception of HUS due to a severe disseminated infection caused by Streptococcus; 2) HUS related to complement, such HUS is also known as "atypical HUS" and is not diarrhea associated (D-HUS, aHUS); but recent studies have shown other forms of HUS, that can occur in the course of systemic diseases or physiopathological conditions such as pregnancy, after transplantation or after drug assumption...
December 2016: Minerva Pediatrica
https://www.readbyqxmd.com/read/27766045/clinical-evaluation-of-thrombotic-microangiopathy-identification-of-patients-with-suspected-atypical-hemolytic-uremic-syndrome
#14
Yu-Min Shen
Atypical hemolytic uremic syndrome (aHUS) is a rare genetic disorder caused by defective complement regulation resulting in thrombotic microangiopathy (TMA). Patients can present as children or adults. The syndrome consists of hemolytic anemia with schistocytosis, thrombocytopenia, significant renal damage, and/or other organ system dysfunction(s). Patients with aHUS may succumb to the complications of the disease with the very first manifestation; surviving patients often suffer from progressive organ dysfunction with significant morbidity and mortality despite plasma infusion or plasma exchange...
2016: Thrombosis Journal
https://www.readbyqxmd.com/read/27753021/non-invasive-prenatal-diagnosis-of-feto-maternal-platelet-incompatibility-by-cold-high-resolution-melting-analysis
#15
Marta Ferro, Hada C Macher, Pilar Noguerol, Pilar Jimenez-Arriscado, Patrocinio Molinero, Juan M Guerrero, Amalia Rubio
Fetal and Neonatal alloimmune thrombocytopenia (FNAIT) is a condition which could occur when pregnant women develop an alloimmunization against paternally inherited antigens of the fetal platelets. Approximately 80 % of FNAIT cases are caused by anti-HPA-1a, about 15 % by anti-HPA-5b and 5 % by other HPA antibodies. Only 2 % of the total population is HPA-1a negative (HPA-1b1b). The HPA-1a allele differs by one single nucleotide from HPA-1b allele, yet it represents around 27 % of total severe thrombocytopenias...
2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27748520/maternal-hla-genotyping-is-not-useful-for-predicting-severity-of-fetal-and-neonatal-alloimmune-thrombocytopenia
#16
Susanna Sainio, Kaija Javela, Jarno Tuimala, Katri Haimila
Lack of reliable laboratory parameters is the main challenge in the management of fetal and neonatal alloimmune thrombocytopenia (FNAIT). Despite the long-known association between the HLA-DRB3*01:01 allele and human platelet antigen 1a (HPA-1a) alloimmunisation, maternal human leucocyte antigen (HLA) typing has been of little clinical value. Recently, other DRB3 allele variants have been suggested to predict the severity of FNAIT. In this nationwide population-based retrospective cohort study, we performed extensive HLA typing of 96 women, accounting for 87% of our cohort of 110 families with confirmed or possible HPA-1a-immunisation...
October 17, 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27728915/fetal-and-neonatal-alloimmune-thrombocytopenia-management-and-outcome-of-a-large-international-retrospective-cohort
#17
Marije M Kamphuis, Heidi Tiller, E S van den Akker, Magnus Westgren, Eleonor Tiblad, Dick Oepkes
OBJECTIVE: To evaluate the management and outcome of a large international cohort of cases of pregnancies complicated by fetal and neonatal alloimmune thrombocytopenia (FNAIT). METHODS: This was an observational prospective and retrospective cohort study of all cases of FNAIT entered into the international multicentre No IntraCranial Haemorrhage (NOICH) registry during the period of 2001-2010. We evaluated human platelet antigen (HPA) specificity, the antenatal and postnatal interventions performed, and clinical outcome...
October 12, 2016: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/27708976/the-clinical-significance-of-antiphospholipid-antibodies-in-systemic-lupus-erythematosus
#18
Ozan Ünlü, Stephane Zuily, Doruk Erkan
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage...
June 2016: Eur J Rheumatol
https://www.readbyqxmd.com/read/27699233/t-cell-responses-to-human-platelet-antigen-1a-involve-a-unique-form-of-indirect-allorecognition
#19
Maria Therese Ahlen, Anne Husebekk, Ida Løken Killie, Bjørn Skogen, Tor Brynjar Stuge
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a pregnancy-related condition caused by maternal antibodies binding an alloantigen on fetal platelets. In most cases the alloantigen is formed by a single amino acid, integrin β3 Leu33, referred to as human platelet antigen-1a (HPA-1a). Production of anti-HPA-1a antibodies likely depends on CD4(+) T cells that recognize the same alloantigen in complex with the HLA-DRA/DRB3*01:01 molecule. While this complex is well characterized, T cell recognition of it is not...
September 8, 2016: JCI Insight
https://www.readbyqxmd.com/read/27648610/thrombotic-thrombocytopenic-purpura-and-atypical-hemolytic-uremic-syndrome-microangiopathy-in-pregnancy
#20
Marie Scully
Thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) are thrombotic microangiopathies (TMAs) that can present in pregnancy. The presentation can be with typical microangiopathic features and thrombocytopenia, but there is also a significant risk of in-utero fetal loss. TTP presents most commonly in the third trimester and aHUS in the postpartum period. On presumptive diagnosis, plasma exchange should be started and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity measured...
September 20, 2016: Seminars in Thrombosis and Hemostasis
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