













基于妊娠合并 ITP发病率低,目前缺乏大样本量、高质量的随机对照试验研究,证据等级尚低。因此,本共识内容仅在现状下为规范化管理妊娠合并ITP提供参考。
执笔专家:梁梅英(北京大学人民医院)、徐雪(北京大学人民医院)、张晓辉(北京大学人民医院)、杨慧霞(北京大学第一医院)
参与本共识制定与讨论的专家:
产科专家(按姓氏拼音排序):高劲松(中国医学科学院北京协和医院)、古航(海军军医大学长海医院)、贺晶(浙江大学医学院附属妇产科医院)、胡娅莉(南京大学医学院附属鼓楼医院)、李力(陆军军医大学大坪医院)、林建华(上海交通大学医学院附属仁济医院)、蔺莉(北京大学国际医院)、刘兴会(四川大学华西第二医院)、刘喆(北京大学第一医院)、马润玫(昆明医科大学第一附属医院)、马玉燕(山东大学齐鲁医院)、王谢桐(山东省立医院)、时春艳(北京大学第一医院)、杨京晶(北京大学人民医院)、张卫社(中南大学湘雅医院)
血液科专家(按姓氏拼音排序):付海霞(北京大学人民医院)、侯宇(山东大学齐鲁医院)、王文生(北京大学第一医院)新生儿科专家(按姓氏拼音排序):侯新琳(北京大学第一医院)、刘捷(北京大学人民医院)、严荔煌(北京大学人民医院)
麻醉科专家(按姓氏拼音排序):丁婷(北大大学第一医院)、张红(北京大学人民医院)
参考文献:
[1] Zufferey A, Kapur R, Semple JW. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP)[J]. J Clin Med, 2017, 6(2):16. DOI: 10.3390/jcm6020016.
[2] Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia[J].
Blood Adv, 2019, 3(22): 3780‑3817. DOI: 10.1182/bloodadvances.2019000812.
[3] Loustau V, Debouverie O, Canoui‑Poitrine F, et al. Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women[J].Br J Haematol, 2014, 166(6): 929‑935. DOI: 10.1111/bjh.12976.
[4] Care A, Pavord S, Knight M, et al. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study[J]. BJOG, 2018, 125(5): 604‑612. DOI:10.1111/1471‑0528.14697.
[5] Xu X, Liang MY, Dou S, et al. Evaluation of glucocorticoid compared with immunoglobulin therapy of severe immune thrombocytopenia during pregnancy: response rate and complication[J]. Am J Reprod Immunol, 2018,80(4):e13000. DOI: 10.1111/aji.13000.
[6] Sun D, Shehata N, Ye XY, et al. Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy[J]. Blood, 2016, 128(10):1329‑1335. DOI: 10.1182/blood‑2016‑04‑710285.
[7] Letsky EA, Greaves M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology[J]. Br J Haematol, 1996, 95(1):21‑26.
[8] Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy[J]. Br J Haematol, 2003, 120(4):574‑596. DOI: 10.1046/j.1365‑2141.2003.04131.x.
[9] Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence‑based practice guideline for immune thrombocytopenia[J]. Blood, 2011, 117(16):4190‑4207. DOI: 10.1182/blood‑2010‑08‑302984.
[10] Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia[J]. Blood, 2010,115(2):168‑186. DOI: 10.1182/blood‑2009‑06‑225565.
[11] Practice Bulletin No. 166: thrombocytopenia in pregnancy[J]. Obstet Gynecol, 2016, 128(3): e43‑53. DOI: 10.1097/AOG.0000000000001641.
[12] Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia[J]. Blood Adv, 2019, 3(23):3829‑3866.DOI: 10.1182/bloodadvances.2019000966.
[13] ACOG Practice Bulletin No. 207 Summary:Thrombocytopenia in pregnancy[J]. Obstet Gynecol, 2019,133(3):589‑591. DOI: 10.1097/AOG.0000000000003101.
[14] 中华医学会血液学分会血栓与止血学组. 成人原发免疫性血小板减少症诊断与治疗中国指南(2020年版)[J].中华血液学杂志, 2020, 41(8): 617‑623. DOI: 10.3760/cma. j.issn.0253‑2727.2020.08.001.
[15] Miyakawa Y, Kashiwagi H, Takafuta T, et al. Consensus report for the management of pregnancy with primary immune thrombocytopenia[J]. Rinsho Ketsueki, 2014,55(8):934‑947.
[16] 徐雪,梁梅英,郭天元. 2014年日本“妊娠合并特发性血小板减少性紫癜诊疗共识”解读[J].中华围产医学杂志, 2015, 18(4):246‑251. DOI: 10.3760/cma.j.issn.1007‑9408.2015.04.001.
[17] Reese JA, Peck JD, Yu Z, et al. Platelet sequestration and consumption in the placental intervillous space contribute to lower platelet counts during pregnancy[J].Am J Hematol, 2019, 94(1): E8‑E11. DOI: 10.1002/ajh.25321.
[18] Reese JA, Peck JD, Deschamps DR, et al. Platelet counts during pregnancy[J]. N Engl J Med, 2018, 379(1): 32‑43.DOI: 10.1056/NEJMoa1802897.
[19] Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy[J]. Blood, 2013, 121(1):38‑47. DOI: 10.1182/blood‑2012‑08‑448944.
[20] Rodeghiero F, Stasi R, Gernsheimer T, et al.Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults
and children: report from an international working group[J]. Blood, 2009, 113(11): 2386‑2393. DOI: 10.1182/blood‑2008‑07‑162503.
[21] Kong Z, Qin P, Xiao S, et al. A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy[J]. Blood, 2017, 130(9):1097‑1103. DOI: 10.1182/blood‑2017‑01‑761262.
[22] Bauer ME, Arendt K, Beilin Y, et al. The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia[J]. Anesth Analg, 2021, 132(6):1531‑1544. DOI: 10.1213/ANE.0000000000005355.
[23] Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate[J]. Blood Rev, 2008, 22(4): 173‑186. DOI:10.1016/j.blre.2008.03.004.
[24] Elgendy MM, Durgham R, Othman HF, et al. Platelet transfusion and outcomes of preterm infants: a cross‑sectional study[J]. Neonatology, 2021, 118(4):425‑433. DOI: 10.1159/000515900.
[25] Bayhan T, Tavil B, Korkmaz A, et al. Neonates born to mothers with immune thrombocytopenic purpura: a single‑center experience of 20 years[J]. Blood Coagul
Fibrinolysis, 2016, 27(1): 19‑23. DOI: 10.1097/MBC.0000000000000378.
[26] Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy[J]. Semin Hematol, 2000, 37(3): 275‑289. DOI: 10.1016/s0037‑1963(00)90106‑9.
[27] Bussel JB, Zabusky MR, Berkowitz RL, et al. Fetal alloimmune thrombocytopenia[J]. N Engl J Med, 1997,337(1):22‑26. DOI: 10.1056/NEJM199707033370104.
[28] American College of Obstetricians and Gynecologists. ACOG practice bulletin: thrombocytopenia in pregnancy. Clinical management guidelines for obstetrician‑gynecologists[J]. Int J Gynaecol Obstet, 1999, 67(2):117‑128.
[29] Subbaiah M, Kumar S, Roy KK, et al. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura[J].Arch Gynecol Obstet, 2014, 289(2): 269‑273. DOI:10.1007/s00404‑013‑2958‑x.
[30] Donato H. Neonatal thrombocytopenia: a review. I.Definitions, differential diagnosis, causes, immune thrombocytopenia[J]. Arch Argent Pediatr, 2021, 119(3):
e202‑e214. DOI: 10.5546/aap.2021.eng.e202.
[31] van der Lugt NM, van Kampen A, Walther FJ, et al.Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic purpura[J].Vox Sang, 2013, 105(3): 236‑243. DOI: 10.1111/vox.12036.
[32] Kawaguchi K, Matsubara K, Takafuta T, et al. Factors predictive of neonatal thrombocytopenia in pregnant women with immune thrombocytopenia[J]. Int J Hematol,2014, 99(5):570‑576. DOI: 10.1007/s12185‑014‑1562‑6.
[33] Kimberlin DW, Brady MT, Jackson MA, et al. Red book:2018 report of the Committee on Infectious Diseases[M].31st ed. Itasca: American Academy of Pediatrics, 2018: 39.
[34] 郑跃杰,张丹霞,李永柏,等.儿童预防接种禁忌证基层筛查及转诊建议(深圳)[J]. 中华实用儿科临床杂志, 2021, 36(16):1201‑1204. DOI: 10.3760/cma.j.cn101070‑20210723‑00867.
[35] Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol, 2020,72(4):529‑556. DOI: 10.1002/art.41191.
[36] Hauschner H, Rosenberg N, Seligsohn U, et al. Persistent neonatal thrombocytopenia can be caused by IgA antiplatelet antibodies in breast milk of immune thrombocytopenic mothers[J]. Blood, 2015, 126(5):661‑664. DOI: 10.1182/blood‑2014‑12‑614446.