Therapeutic apheresis in pregnancy: General considerations and current practice

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• 作者：Piero Marson^a ; ^{piero.marson@sanita.padova.it" class="auth_mail" title="E-mail the corresponding author} ; Maria Teresa Gervasi^b ; Tiziana Tison^a ; Anna Colpo^a ; Giustina De Silvestro^a
• 关键词：Therapeutic apheresis ; Pregnancy ; ASFA guidelines ; Hemolytic disease of the newborn
• 刊名：Transfusion and Apheresis Science
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：53
• 期：3
• 页码：256-261
• 全文大小：250 K

文摘

It is widely known that pregnancy does not represent a contraindication to therapeutic apheresis (TA) techniques. In fact, since the first experiences of TA in pregnancy for the prevention of hemolytic disease of the newborn, several diseases are at present treated with TA, mainly within 6 clinical categories: (a) TA is a priority and has no alternative equally effective treatment (e.g., thrombotic thrombocytopenic purpura); (b) TA is a priority but there are alternative therapies not contraindicated in pregnancy (e.g., myasthenia gravis); (c) TA is an effective tool of saving/avoiding drugs contraindicated in pregnancy (e.g., systemic lupus erythematosus); (d) TA is a treatment of specific conditions/complications of pregnancy with maternal and/or fetal risk (e.g., antiphospholipid syndrome); (e) TA is a treatment of specific conditions of pregnancy with exclusive fetal risk (e.g., hemolytic disease of the newborn); (f) TA is a treatment of disease which is strongly indicated and can exceptionally occur during pregnancy (e.g., Goodpasture's syndrome).

When dealing with TA pregnant patients, some technical aspects due to the physiological changes of gestation have to be carefully considered, in particular the increase of the circulating blood volume. Moreover a multidisciplinary medical team, including an obstetrician, a clinical consultant, specialist in TA and in transfusion medicine, and a neonatologist stand as a basic requirement for the proper management of some clinical conditions that may be characterized by high maternal and fetal risk.