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Anne H. Beressi; Ayalew Tefferi, MD; Murray N. Silverstein, MD, PhD; Robert M. Petitt, MD; H. Clark Hoagland, MD

Arch Intern Med. 1995;155(11):1217-1222.

Abstract
Objective
To evaluate the clinical impact of essential thrombocythemia on the outcome of pregnancy or vice versa.

Design
A retrospective study.

Setting
All patients were seen at our tertiary referral center, and most were followed up by their local physicians.

Patients
From 1975 through 1991, 73 women younger than 50 years with essential thrombocythemia were seen at our institution. All patients were followed up through patient or physician contact. A detailed obstetric history, including peripartum complications and management, was obtained.

Results
Among the 73 women, 34 pregnancies occurred in 18 patients. There were two uncomplicated elective abortions and one ectopic pregnancy. Of the 31 other pregnancies, 17 (55%) resulted in live birth and 14 (45%) ended in spontaneous abortion (all but two in the first trimester). Abortion could not be predicted from history of disease complications before or during pregnancy or by the presence or absence of specific therapy during pregnancy. Preconception platelet counts in women whose pregnancies resulted in live birth were similar to those of women whose pregnancies ended in abortion. Other complications during pregnancy were rare.

Conclusions
Patients with essential thrombocythemia have an increased risk of first-trimester abortion, which does not appear to be predictable or influenced by therapy. However, most patients are able to carry pregnancies to term with little or no risk of obstetric or thrombohemorrhagic complications during or after delivery. Overall, specific therapy during pregnancy did not appear to modify the clinical outcome, and the benefit of platelet apheresis during delivery could not be substantiated.

(Arch Intern Med. 1995;155:1217-1222)

Author Affiliations
From the Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn.

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