PB1395 - Pregnancy as a protective factor for bleeding in immune thrombocytopenia regardless of platelet count

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

CF

Chuliber Fernando, MD

MD Hematologist
Grupo CAHT
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Co-Author(s)

AM

Agustín Matías Muñoz

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
LL

Lucía Llera

MD
Hematology. Clinical Department. Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
Veronica Privitera

MD
Hospital Italiano de Buenos Aires
Ciudad Autónoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
DM

Daniela Mezzarobba

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
MV

Maximiliano Villagra Iturre

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
EV

Estela Viñuales

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
JA

Jorge Arbelbide

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
DP

Diana Penchasky

MD
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Background: Immune thrombocytopenia (ITP) has distinct features in pregnancy, accounting for 1-2/1000 of them

Aims: To compare the proportion of bleeding between pregnant and non-pregnant ITP patients and describe the clinical characteristics and treatment in pregnant ITP patients

Methods: We retrospectively included a cohort of ITP pregnant women who attended a university hospital between 2007-2021. Patients with a diagnosis of ITP in pregnancy or with a relapse in pregnancy were considered. A comparison was performed with a group of consecutive IT non-pregnant women (1:1) of the same age range. A multiple logistic regression model was constructed to evaluate the pregnancy/bleeding relationship.

Results: Thirty-four ITP pregnant patients (38 pregnancies) were analyzed and, 38 non-pregnant women with ITP were as a comparator group. The proportion of patients who bled was significantly lower in the pregnant group. A small proportion presented major bleeding in both groups (Table 1). Pregnant patients had higher platelet counts (at diagnosis and nadir). Fewer pregnant women required treatment for ITP, but the rate of complete response (>100x109/L) was higher in non-pregnant women (table 1).
In the bivariate analysis, a platelet count (nadir) lower than 30 x109/L was associated with a higher risk of bleeding [ORc 18.56(95%CI 5.36- 64.18),p < 0.0001]. In contrast, pregnancy was a protective factor of bleeding [ORc 0.03(95%CI 0.007-0.12),p < 0,001]. In the multivariate analysis, pregnancy persisted as a protective factor regardless of platelet count [ORa 0.04(95%CI 0.01-0.20),p < 0.0001].
In the pregnant group, 47% had a history of ITP. In 21 pregnancies, it was necessary to initiate treatment for ITP. The main indication was a low platelet count with a high risk of bleeding. Corticosteroids were the most common therapy.. Thirty-eight percent of the therapies were indicated in preparation for delivery (Table 2).

Conclusion(s): We observed that ITP pregnant patients had significantly lower hemorrhagic manifestations than non-pregnant patients regardless of platelet count.