Actress/singer Mandy Moore is pregnant with her second child, due this October. This Is Us co-star recently revealed that she will be giving birth without medication with this baby, just like she did with her first boy, Gus . She was unable to receive an epidural during labor because she had immune thrombocytopenic purpura (ITP), an autoimmune disease that depletes platelets.
During her first pregnancy, her platelet count “dipped exponentially” and she needed to have her platelet count checked weekly. Delivery was difficult and required a vacuum, but Mother and child are doing great. Now Moore says, “My platelets are too low to get an epidural…it’s horrible. But I can do it again. I can climb that mountain again. “
On today , Moore shared: “I’m fine. I just have to keep checking my blood throughout my pregnancy – checking my platelet levels. They’re low, but they’ve been low. But I am fine. all is well. “
After it’s done This is Us, which ended 6 seasons in May, Moore had planned to focus on her She has a singing career and embarked on a North American tour to promote her In Real Life album. However, she recently canceled the remainder of the tour, writing on Instagram: “When I wasn’t pregnant when we booked these shows, although I really thought I could have caught up with the way we traveled (long time on the bus, not getting the proper rest), paid the price and made me feel like it’s going on So challenging. I know I have to put my family and my health (and the health of my baby) first, and this is where I am at my best right now. “
Immune thrombocytopenic purpura
ITP is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is characterized by low platelet counts, purpura and bleeding episodes. Immunoglobulin G (IgG) autoantibodies cause sensitization of circulating platelets. Then These platelets are removed by antigen-presenting cells, such as macrophages, promonocytes, and their precursor cells found in the spleen, liver, lung, and bone marrow. Diagnosis is usually made by excluding other causes of thrombocytopenia.
ITP can be acute or chronic, and is demarcated between the two at approximately 6 months of age. Acute ITP is more common in boys and girls and is the most common type of ITP. It usually precedes due to viral infection. Chronic ITP affects individuals 20-50 years of age and is three times more common in women than in men. Pre-existing viral infection is usually absent.
It is estimated that each year global The incidence of ITP is approximately 1 to 6 per 100,000 adults. In the United States, the prevalence is approximately 8 per 100,000 children and 12 per 100,000 adults.
Symptoms
Many people with ITP are asymptomatic and otherwise appear healthy. However, ITP Can cause bleeding that is difficult to stop. Bleeding may be internal, subcutaneous, or broken skin.
Signs of bleeding may include:
Petechia
Lab Results
Laboratory results may include:
- Low platelet count, usually
- Peripheral Blood smear: normal red and white blood cells. Platelet size can be normal, but there are also varying numbers of large platelets.
Bone marrow examination showed thrombocytosis in the number of megakaryocytes.
Treatment of ITP
For most children and adults, ITP is not serious. Acute ITP in children usually resolves on its own within weeks or months without recurrence.
Chronic ITP varies from person to person and can last for many years. Even people with severe chronic ITP can live for decades. Most people with chronic ITP can stop treatment at some point and maintain a safe platelet count.
Treatment depends on the patient’s platelet count and whether they have any symptoms. In mild cases, if there is regular monitoring, no treatment is necessary.
In patients with very low platelet counts and/or active bleeding and/or impending surgery, medications may be used to increase platelet levels. The most commonly used are corticosteroids, such as prednisone and dexamethasone. Other drugs used to increase platelet counts include eltrombopag, intravenous immune globulin (IVIG), rituximab, fosematinib, and romiprostim.
Splenectomy is commonly used in adult patients with ITP with persistent symptomatic thrombocytopenia. Splenectomy is associated with a lifetime increased risk of sepsis with encapsulated bacteria. The risk in adults is estimated to be approximately 1%, with approximately 1 fatal outcome per 1500 patient-years.
Pregnancy and platelet disorders
Platelets Hypopenia, defined as platelet count 9/L, compared during pregnancy Common, occurring in 7%-12% of pregnancies at the time of delivery. Pregnancy thrombocytopenia accounts for 70%-80%, hypertensive disorders (such as preeclampsia or HELLP syndrome) account for 20%, and ITP accounts for about 3%-4%.
Thrombocytopenia in pregnancy is due to a combination of hemodilution, increased platelet consumption in peripheral tissues, and elevated thromboxane A2 levels resulting in increased platelet aggregation. It is usually mild (between 130-150,000 platelets) and has no significant effect on the mother or fetus. It usually does not require treatment other than regular monitoring of platelet and blood cell counts.
Risks of low platelet counts during pregnancy include:
- Epidural cannot be given during labor due to risk of epidural hematoma that can lead to spinal cord injury
- Increased bleeding during vaginal or cesarean section
- if thrombocytopenia is due to severe preeclampsia due to premature birth
- Fetal-Neonatal Alloimmune Thrombocytopenia (Rare)
- Vaginal Surgery or Caesarean Section: 50,000
- Epidermal anesthesia: 75,000-80,000
Current guidelines for platelet counts for safe delivery/anaesthesia are as follows:
Vaginal Birth: 30,000
Pregnancy ITP
In women with ITP, thrombocytopenia usually worsens during pregnancy. Nearly half required treatment. The decision to start treatment depends on the stage of pregnancy, platelet count, and whether there are any signs of bleeding. Platelets can be safely maintained at 20,000 in the first and second trimesters unless there are signs of bleeding or surgery is required. In the third trimester, a platelet count> 50,000 is preferred. Fortunately, most women don’t experience heavy bleeding during labor.
First-line therapy is similar to non-pregnant patients—IVIG and corticosteroids. They have the same efficacy as non-pregnant patients, with minimal risk to the fetus.
Birth methods for women with ITP are based on obstetric management. Ideally, the platelet count should be>50,000 for vaginal delivery and>70,000 for cesarean delivery or epidural anesthesia. Emergency caesarean section can be performed under general anesthesia with a platelet count>30,000. Women with ITP are at increased risk of venous thrombosis and should use routine precautions as directed. ITP can worsen postpartum, and women should be closely monitored for signs of bleeding.
After delivery, neonates should be closely monitored for thrombocytopenia, which occurs in 21%-28% of cases, possibly from passive transport of platelet antigens by maternal autoantibodies . Cord blood platelet counts can be obtained, and if
Most women with ITP can breastfeed their babies, although it rarely causes persistent neonatal thrombocytopenia. This resolves after stopping breastfeeding. After the neonatal thrombocytopenia resolves, the mother can continue to pump to maintain the breast milk supply and resume breastfeeding.
Michele R. Berman, MD, Pediatrician – turned medical journalist. She has trained at Johns Hopkins University, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: reporting on common diseases affecting rare populations and summarizing the evidence-based medicine behind the headlines.
