Essential Thrombocythemia During Pregnancy

Abstract

Essential thrombocythemia is a myeloproliferative disorder of the platelet line. The diagnosis is established with the findings of a platelet count greater than 600,000/jil, normal hemoglobin and hematocrit, and the absence of a Philadelphia chromosome. The disease usually becomes manifest by episodes of thrombosis or bleeding. Conditions which increase the risk for thrombosis may create complications for patients with essential thrombocythemia. We present a case of a patient with an uncomplicated pregnancy with platelet counts ranging from 1,258,000 to 942,000/ud. She was managed antenatally with 75 mg of aspirin per day. She was delivered at term of a healthy 8 pound 4 ounce male. Her postpartum course was managed with subcutaneous heparin 10,000 units bid for 6 weeks. Including this case, a review of the literature details 12 women with 34 pregnancies associated with ET. Of these 34 pregnancies there were 23 spontaneous abortions, 2 elective abortions, 2 intrauterine fetal demises, 1 premature liveborn, and 6 term liveborns. Four of the women with liveborn infants received some form of medical therapy including aspirin, platelet pheresis, or chemotherapy. One woman developed postpartum complications related to essential thrombocythemia. Patients with essential thrombocythemia should be considered candidates for antiplatelet therapy including platelet pheresis. Postpartum antiplatelet therapy should also be considered in patients with this disease.

Key Words:

• Platelets
• Pregnancy
• Thrombocythemia