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Chapter 37 - Thrombocytopenia and Bleeding Disorders in Pregnancy (Content last reviewed: 11th November 2020)

from Section 5 - Late Pregnancy – Maternal Problems

Published online by Cambridge University Press:  15 November 2017

David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
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Summary

Platelets are anuclear, biconcave fragments, 1.5–3 μm in diameter, which stain purple on a peripheral blood film. Normal platelet ranges cited by laboratories vary, with lower limits around 140–150 × 109/L and upper limits at 400–450 × 109/L.

Type
Chapter
Information
High-Risk Pregnancy
Management Options
, pp. 1043 - 1083
Publisher: Cambridge University Press
First published in: 2017

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References

Matthews, JH, Benjamin, S, Gill, DS, Smith, NA. Pregnancy-associated thrombocytopenia: definition, incidence and natural history. Acta Haematol 1990; 84:24–9.CrossRefGoogle ScholarPubMed
Boehlen, F, Hohlfeld, H, Extermann, P, Perneger, T, de Moerloose, P. Platelet count at term pregnancy: a reappraisal of the threshold. Obstet Gynecol 2000; 95: 2933.Google Scholar
Han, L, Liu, X, Li, H, et al. Blood coagulation parameters and platelet indices: changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One 2014; 9: e114488. doi: 10.1371/journal.pone.0114488.Google Scholar
Karlsson, O, Jeppsson, A, Hellgren, MA. Longitudinal study of factor XIII activity, fibrinogen concentration, platelet count and clot strength during normal pregnancy. Thromb Res 2014; 134: 750–2.Google Scholar
Fay, RA, Hughes, AO, Farron, NT. Platelets in pregnancy: hyperdestruction in pregnancy.Obstet Gynecol 1983; 61: 238–40.Google Scholar
Sainio, S, Kekomaki, R, Riikonen, S, Teramo, K. Maternal thrombo-cytopenia at term: a population-based study. Acta Obstet Gynecol Scand 2000; 79: 744–9.CrossRefGoogle Scholar
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. Blood 2009; 113: 2386–93.Google Scholar
American Society of Hematology. Clinical Practice Guide on Thrombocytopenia in Pregnancy. Washington, DC: ASH, 2013. http://www.hematology.org/Clinicians/Guidelines-Quality/Quick-Ref/530.aspx (accessed March 2017).Google Scholar
Myers, B. Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol 2012; 158: 315. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09135.x/pdf (accessed March 2017).Google Scholar
Gernsheimer, T, James, AH, Stasi, R. How I treat thrombocytopenia in pregnancy. Blood 2013; 121: 3847. http://www.bloodjournal.org/content/121/1/38 (accessed March 2017).Google Scholar
National Institute for Health and Care Excellence. Intrapartum care for women with existing medical conditions or obstetric complications and their babies. NICE Guideline NG121. London: NICE, 2019. www.nice.org.uk/guidance/ng121 (accessed September 2019).Google Scholar
Burrows, RF, Kelton, JG. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries. Am J Obstet Gynecol 1990; 162: 731–4.Google Scholar
Burrows, RF, Kelton, JG. Platelets and pregnancy. In Lee, RV (ed.), Current Obstetric Medicine. St. Louis, MO: Mosby-Year Book, 1993, Vol. 2, p. 83.Google Scholar
Win, N, Rowley, M, Pollard, C, et al. Severe gestational (incidental) thrombocytopenia: to treat or not to treat. Haematology, 2005; 10: 6972.Google Scholar
Kwon, JY, Shin, JC, Lee, JW, Kim, SP, Rha, JG. Predictors of idiopathic thrombocytopenic purpura in pregnant women presenting with thrombocytopenia. Int J Gynaecol Obstet 2007; 96: 85–8.CrossRefGoogle ScholarPubMed
Horn, EH. Platelets in normal and hypertensive pregnancy. Platelets 1991; 2: 183–95.CrossRefGoogle ScholarPubMed
Douglas, JT, Shah, M, Lowe, GD, et al. Plasma fibrinopeptide A and beta-thromboglobulin in pre-eclampsia and pregnancy hypertension. Thromb Haemost 1982; 47: 54–5.Google Scholar
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. Br J Haematol 1996; 95: 21–6.Google ScholarPubMed
Burrows, RF, Kelton, JG. Incidentally detected thrombocytopenia in healthy mothers and their infants. N Engl J Med 1988; 319: 142–5.CrossRefGoogle ScholarPubMed
British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003; 120: 574–96.Google Scholar
McCrae, KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program 2010; 2010: 397402. doi: 10.1182/asheducation-2010.1.397.Google Scholar
Shalev, O, Anteby, E. Epidural anesthesia can be safely performed in gestational thrombocytopenia of >50,000/uL [abstract]. Blood 1996; 88: 62a.Google Scholar
Provan, A, Stasi, R, Newland, AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115: 168–86. http://www.bloodjournal.org/content/115/2/168 (accessed March 2017).Google Scholar
van Veen, JJ, Nokes, TJ, Makris, M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol 2010; 148: 1525.Google Scholar
Neunert, C, Lim, W, Crowther, M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117: 4190–207. http://www.bloodjournal.org/content/117/16/4190 (accessed March 2017).Google Scholar
Nugent, D, McMillan, R, Nichol, JL, Slichter, SJ. Pathogenesis of chronic immune thrombocytopenia: increased platelet destruction and/or decreased platelet production. Br J Haematol 2009; 146: 585–96.Google Scholar
Abrahamson, KK, Hall, SA, Feudjo-Tepie, M, Mitrani-Gold, FS, Logie, J. The incidence of idiopathic thrombocytopenic purpura among adults: a population-based study and literature review. Eur J Haematol 2009; 83: 83–9.CrossRefGoogle ScholarPubMed
Gill, KK, Kelton, JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Hematol 2000; 37: 275–89.Google Scholar
Segal, JB, Powe, NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost 2006; 4: 2377–83.Google Scholar
Webert, KE, Mittal, R, Sigouin, C, Heddle, NM, Kelton, JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 2003; 102: 4306–11.CrossRefGoogle ScholarPubMed
Johnsen, J. Pathogenesis in immune thrombocytopenia: new insights. Hematology Am Soc Hematol Educ Program 2012; 2012: 306–12. http://asheducationbook.hematologylibrary.org/content/2012/1/306.full (accessed March 2017).Google ScholarPubMed
Calderwood, C. Thromboembolism and thrombophilia in pregnancy. Curr Obstet Gynaecol 2006; 16: 321–6.Google Scholar
Veneri, D, Franchini, M, Raffaelli, R, et al. Idiopathic thrombocytopenic purpura in pregnancy: analysis of 43 consecutive cases followed at a single Italian institution. Ann Hematol 2006; 85: 552–55.Google Scholar
Won, YW, Moon, W, Yun, YS, et al. Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura (ITP). Korean J Intern Med 2005; 20: 129–34.CrossRefGoogle ScholarPubMed
Fujimura, K, Harada, Y, Fujimoto, T, et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int J Hematol 2002; 75: 426–33.CrossRefGoogle ScholarPubMed
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. Br J Haematol 2014; 166: 929–35.CrossRefGoogle ScholarPubMed
Schiavotto, C, Ruggeri, M, Rodeghiero, F. Adverse reactions after high-dose intravenous immunoglobulin: incidence in 83 patients treated for idiopathic thrombocytopenic purpura (ITP) and review of the literature. Haematologica (1993); 78 (6 suppl 2): 3540.Google ScholarPubMed
Cayco, AV, Perazella, MA, Hayslett, JP. Renal insufficiency after intravenous immune globulin therapy: a report of two cases and an analysis of the literature. J Am Soc Nephrol 1997; 8: 1788–94.Google Scholar
Ozkan, H, Cetinkaya, M, Koksal, N, et al. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura. J Perinatol 2010; 30: 3844.Google Scholar
Gasim, T. Immune thrombocytopenia in pregnancy: a reappraisal of obstetric management and outcome.J Reprod Med 2011; 56: 163–8.Google Scholar
Jensen, JF, Wiedmeier, SE, Henry, E, Silver, RM, Christensen, RD. Linking maternal platelet counts with neonatal platelet counts and outcomes using the data repositories of a multihospital health care system. Am J Perinatol 2011; 28: 597604.Google Scholar
Burrows, RF, Kelton, JG. Fetal thrombocytopenia and its relationship to maternal thrombocytopenia. N Engl J Med 1993; 329: 1463–6.Google Scholar
Kawaguchi, K, Matsubara, K, Takafuta, T, et al. Factors predictive of neonatal thrombocytopenia in pregnant women with immune thrombocytopenia. Int J Hematol 2014; 99: 570–6.Google Scholar
Koyama, S, Tomimatsu, T, Kanagawa, T, et al. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol 2012; 87: 1521.Google Scholar
Samuels, P, Bussel, JB, Braitman, LE, et al. Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura. N Engl J Med 1990; 323: 229–35.Google Scholar
Payne, SD, Resnik, R, Moore, TR, Hedriana, HL, Kelly, TF. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia. Am J Obstet Gynecol 1997; 177: 149–55.Google Scholar
Scioscia, AL, Grannum, PA, Copel, JA, Hobbins, JC. The use of percutaneous umbilical blood sampling in immune thrombocytopenic purpura. Am J Obstet Gynecol 1988; 159: 1066–8.CrossRefGoogle ScholarPubMed
Cines, DB, Bussel, JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005; 106: 2244–51.Google Scholar
Care, A, Pavord, S, Knight, M, Alfirevic, Z. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. BJOG 2018; 125: 604–12. doi: 10.1111/1471-0528.14697Google ScholarPubMed
Schwartz, J, Leber, MD, Gillis, SM, et al. Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 2003; 72: 94–8.Google Scholar
Kojouri, K, Vesely, SK, Terrell, DR, George, JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 2004; 104: 2623–34.Google Scholar
Shanafelt, TD, Madueme, HL, Wolf, RC, Tefferi, A. Rituximab for immune cytopenia in adults:idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, and Evans syndrome. Mayo Clin Proc 2003; 78: 1340–6.Google Scholar
Patel, V, Mihatov, N, Cooper, N, et al. Long term follow-up of patients with immune thrombocytopenic purpura (ITP) whose initial response to rituximab lasted a minimum of 1 year [abstract]. Blood 2006; 108: Abstract 479.CrossRefGoogle Scholar
Kuter, DJ, Bussel, JB, Lyons, RM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet 2008; 371: 395403.Google Scholar
Gernsheimer, TB, George, JN, Aledort, LM, et al. Evaluation of bleeding and thrombotic events during long-term use of romiplostim in patients with chronic immune thrombocytopenia (ITP). J Thromb Haemost 2010; 8: 1372–82.CrossRefGoogle ScholarPubMed
Cheng, G, Saleh, MN, Marcher, C, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet 2011; 377: 393402.Google Scholar
Laskin, CA, Bombardier, C, Hannah, ME, et al. Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N Engl J Med 1997; 337: 148–53.Google Scholar
Christiaens, GC, Nieuwenhuis, HK, von dem Borne, AE, et al. Idiopathic thrombocytopenic purpura in pregnancy: a randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count. Br J Obstet Gynaecol 1990; 97: 893–8.CrossRefGoogle ScholarPubMed
Park-Wyllie, L, Mazzotta, P, Pastuszak, A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62: 385–92.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Bussel, JB, Pham, LC, Aledort, L, Nachman, R. Maintenance treatment of adults with chronic refractory immune thrombocytopenic purpura using repeated intravenous infusions of gammaglobulin. Blood 1988; 72: 121.Google Scholar
Ancona, KG, Parker, RI, Atlas, MP, Prakash, D. Randomized trial of high-dose methylprednisolone versus intravenous immunoglobulin for the treatment of acute idiopathic thrombocytopenic purpura in children. J Pediatr Hematol Oncol 2002; 24: 540–4.Google Scholar
Griffiths, J, Sia, W, Shapiro, AM, Tataryn, I, Turner, AR. Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. J Obstet Gynaecol Can 2005; 27: 771–4.Google Scholar
Alstead, ME, Ritchie, JK, Lennard-Jones, JE, Farthing, MJ, Clark, ML. Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 1990; 99: 443–6.Google Scholar
Davison, JM, Lindheimer, MD. Pregnancy in renal transplant recipients. J Reprod Med 1982; 27: 613–21.Google Scholar
Cleary, BJ, Källén, B. Early pregnancy azathioprine use and pregnancy outcomes. Birth Defects Res A Clin Mol Teratol 2009; 85: 647–54.CrossRefGoogle ScholarPubMed
Gisbert, JP. Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis 2010; 16: 881–95.Google Scholar
Gall, B, Yee, A, Berry, B, et al. Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura. J Obstet Gynaecol Can 2010; 32: 1167–71.CrossRefGoogle ScholarPubMed
Schmid, J, Piroth, D, Buhrlen, M, et al. Successful rituximab treatment of refractory immune thrombocytopenia during pregnancy. Onkologie 2011; 34 (Suppl 6): 240, 0378–584X.Google Scholar
Patil, AS, Dotters-Katz, SK, Metjian, AD, James, AH, Swamy, GK. Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy. Obstet Gynecol 2013; 122: 483–5.Google Scholar
Giermasz, A, Knoche, J, Fogarty, PF. Tolerability and efficacy of romiplostim as management of severe refractory immune thrombocytopenia (ITP) during pregnancy. J Thromb Haemost 2013; 11 (Suppl): 75–6.Google Scholar
Decroocq, J, Marcellin, L, LeRay, C, Willems, L. Rescue therapy with romiplostim for refractory primary immune thrombocytopenia during pregnancy. Obstet Gynecol 2014; 124: 481–3.Google Scholar
Kong, Z, Qin, P, Xiao, S, et al. A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy. Blood 2017; 130: 1097–103. doi: 10.1182/blood-2017-01-761262.Google Scholar
Moise, KJ, Patton, DE, Cano, LE. Misdiagnosis of a normal fetal platelet count after coagulation of intrapartum scalp samples in autoimmune thrombocytopenic purpura. Am J Perinatol 1991; 8: 295–6.Google Scholar
Cook, RL, Miller, RC, Katz, VL. Immune thrombocytopenic purpura in pregnancy: a reappraisal of management. Obstet Gynecol 1991; 78: 578–83.Google Scholar
Keeling, D, Mackie, I, Moore, GW, Greer, IA, Greaves, M; British Committee for Standards in Haematology. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol 2012; 157: 4758. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09037.x/epdf (accessed March 2017).Google Scholar
Pengo, V, Tripodi, A, Reber, G, et al.; Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost 2009; 7: 1737–40. http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2009.03555.x/epdf (accessed March 2017).Google Scholar
Giannakopoulos, B, Krilis, SA. How I treat the antiphospholipid syndrome. Blood 2009; 114: 2020–30. http://www.bloodjournal.org/content/114/10/2020 (accessed March 2017).Google Scholar
Miyakis, S, Lockshin, MD, Atsumi, T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295306.Google Scholar
Cervera, R, Piette, JC, Font, J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum 2002; 46: 1019–27.Google Scholar
Asherson, RA, Khamashta, MA, Ordi-Ros, J, et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine 1989; 68: 366–74.Google Scholar
Ruggeri, M, Tosetto, A, Palandri, F, et al. Thrombotic risk in patients with primary immune thrombocytopenia is only mildly increased and explained by personal and treatment-related risk factors. J Thromb Haemost 2014; 12: 1266–73.Google Scholar
Comellas-Kirkerup, L, Hernández-Molina, G, Cabral, AR. Antiphospholipid-associated thrombocytopenia or autoimmune hemolytic anemia in patients with or without definite primary antiphospholipid syndrome according to the Sapporo revised classification criteria: a 6-year follow-up study. Blood 2010; 116: 3058–63.Google Scholar
Out, HJ, Bruinse, HW, Christiaens, GC, et al. Prevalence of aPL in patients with fetal loss. Ann Rheum Dis 1991; 50, 553–7.Google Scholar
Oku, K, Atsumi, T, Bohgaki, M, et al. Complement activation in patients with primary antiphospholipid syndrome. Ann Rheum Dis 2009; 68: 1030–5.Google Scholar
Di Simone, N, Castellini, R, Caliandro, D, Caruso, A. Antiphospholipid antibodies regulate the expression of trophoblast cell adhesion molecules. Fertil Steril 2002; 77: 805–11.Google Scholar
Bates, SM, Greer, I, Middeldorp, S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e691Se736S.Google Scholar
Mak, A, Cheung, MW, Cheak, AA, Ho, RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology (Oxford) 2009; 49: 281–8.Google Scholar
Newman, K, Owlia, MB, El-Hemaidi, I, Akhtari, M. Management of immune cytopenias in patients with systemic lupus erythematosus: old and new. Autoimmun Rev 2013; 12: 784–91.Google Scholar
Fernandez, M, Alarcon, GS, Apte, M, et al. Systemic lupus erythematosis in a multi-ethnic US cohort: The significance of thrombocytopenia as a prognostic factor. Arthritis Rheum 2007; 56: 614–21.Google Scholar
de Ruiter, A, Taylor, GP, Clayden, P, et al. British HIV Association guidelines for the management of HIV infection in pregnant women 2012(2014 interim review). HIV Med 2014; 15 (Suppl 4): 177. http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/BHIVA-Pregnancy-guidelines-update-2014.pdf (accessed March 2017).Google Scholar
Sullivan, AK, Raben, D, Reekie, J, et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One 2013; 8: e52845.Google Scholar
Morris, L, Distenfeld, A, Amorosi, E, Karpatkin, S. Autoimmune thrombocytopenic purpura in homosexual men. Ann Intern Med 1982; 96: 714–17.Google Scholar
Cines, DB, Liebman, H, Stasi, R. Pathobiology of secondary immune thrombocytopenia. Semin Hematol 2009; 46 (1 Suppl 2): S2–14.Google Scholar
Ucar, A, Fernandez, HF, Byrnes, JJ, Lian, EC, Harrington, WJ. Thrombotic microangiopathy and retroviral infections: A 13 year experience. Br J Haematol 1994; 45: 304–9.Google Scholar
Thompson, GR, Lawrence, VA, Crawford, GE. HIV infection increases the risk of heparin-induced thrombocytopenia. Clin Infect Dis 2007; 45: 1393–6.Google Scholar
Scaradavou, A, Cunningham-Rundles, S, Ho, JL, et al. Superior effect of intravenous anti-D compared with IV gammaglobulin in the treatment of HIV-thrombocytopenia: results of a small, randomized prospective comparison. Am J Hematol 2007; 82: 335–41.CrossRefGoogle ScholarPubMed
Scaradavou, A, Woo, B, Woloski, BM, et al. Intravenous anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood 1997; 89: 2689–700.Google Scholar
Fultz, SL, McGinnis, KA, Skanderson, M, Ragni, MV, Justice, AC. Association of venous thromboembolism with human immunodeficiency virus and mortality in veterans. Am J Med 2004; 116: 420–3.Google Scholar
Chiao, EY, Engels, EA, Kramer, JR, et al. Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120 908 US veterans with hepatitis C virus infection. Arch Intern Med 2009; 169: 357–63.CrossRefGoogle ScholarPubMed
Ranjan, SK, Espina, BM, Liebman, HA. Hepatitis C virus related thrombocytopenia: clinical and laboratory characteristics compared with chronic immune thrombocytopenic purpura. Br J Haematol 2005; 129: 818–24.Google Scholar
Watson, H, Davidson, S, Keeling, D; Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. Guidelines on the diagnosis and management of heparin induced thrombocytopenia: second edition. Br J Haematol 2012; 159: 528–40. http://onlinelibrary.wiley.com/doi/10.1111/bjh.12059/epdf (accessed March 2017).Google Scholar
Royal College of Obstetricians and Gynaecologists. The Acute Management of Thrombosis and Embolism During Pregnancy and the Puerperium. Green-top Guideline No. 37b. London: RCOG, 2010. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37b (accessed March 2017).Google Scholar
Warkentin, TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 2003; 121: 535–55.Google Scholar
Martel, N, Lee, J, Wells, PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood, 2005; 106: 2710–15.Google Scholar
Greer, IA, Nelson-Piercy, C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 2005; 106: 401–7.Google Scholar
Fausset, MB, Vogtlander, M, Lee, RM, et al. Heparin-induced thrombocytopenia is rare in pregnancy. Am J Obstet Gynecol 2001; 185: 148–52.Google Scholar
Lindhoff-Last, E, Kreutzenbeck, HJ, Magnani, HN. Treatment of 51 pregnancies with danaparoid because of heparin intolerance. Thromb Haemost 2005; 93, 63–9.Google Scholar
Ekbatani, A, Asaro, LR, Malinow, AM. Anticoagulation with argatroban in a parturient with heparin-induced thrombocytopenia. Int J Obstet Anesth 2010; 19: 82–7.Google Scholar
Tanimura, K, Ebina, Y, Sonoyama, A, et al. Argatroban therapy for heparin-induced thrombocytopenia during pregnancy in a woman with hereditary antithrombin deficiency. J Obstet Gynaecol Res 2012; 38: 749–52.Google Scholar
National Institute for Health and Care Excellence. Hypertension in Pregnancy: the Management of Hypertensive Disorders During Pregnancy. Clinical Guideline CG107. London: NICE, 2010. https://www.nice.org.uk/guidance/cg107 (accessed March 2017).Google Scholar
American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122–31. http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy (accessed March 2017).Google Scholar
Weinstein, L. Syndrome of hemolysis, elevated liver enzymes and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 1978; 142: 159–67.Google Scholar
Buimer, M, Keijser, R, Jebbink, JM, et al. Seven placental transcripts characterize HELLP-syndrome. Placenta 2008; 29: 444–53.Google Scholar
Irgens, HU, Reisaeter, L, Irgens, LM, Lie, RT. Long term mortality of mothers and fathers after pre eclampsia: population based cohort study. BMJ 2001; 323: 1213–17.Google Scholar
Kirkpatrick, CA. The HELLP syndrome. Acta Clinica 2010; 65: 91–7.Google Scholar
Scully, M, Hunt, BJ, Benjamin, S, et al.; British Committee for Standards in Haematology. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol 2012; 158: 323–35. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09167.x/epdf (accessed March 2017).Google Scholar
Galbusera, M, Noris, M, Remuzzi, G. Thrombotic thrombocytopenic purpura–then and now. Semin Thromb Hemost 2006; 32: 81–9.Google Scholar
Ridolfi, RL, Bell, WR. Thrombotic thrombocytopenic purpura. Report of 25 cases and review of the literature. Medicine (Baltimore) 1981; 60: 413–28.Google Scholar
Vesely, SK, Li, X, McMinn, JR, Terrell, DR, George, JN. Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Transfusion 2004; 44: 1149–58.Google Scholar
Scully, M, Yarranton, H, Liesner, R, et al. Regional UK TTP registry: correlation with laboratory ADAMTS 13 analysis and clinical features. Br J Haematol 2008; 142: 819–26.Google Scholar
Mokrzycki, MH, Rickles, FR, Kaplan, AA, Kohn, OF. Thrombotic thrombocytopenic purpura in pregnancy: successful treatment with plasma exchange. Case report and review of the literature. Blood Purif 1995; 13: 271–82.Google Scholar
Scully, M, Starke, R, Lee, R, et al. Successful management of pregnancy in women with a history of thrombotic thrombocytopaenic purpura. Blood Coagul Fibrinolysis 2006; 17: 459–63.Google Scholar
Ducloy-Bouthors, AS, Caron, C, Subtil, D, et al. Thrombotic thrombocytopenic purpura: medical and biological monitoring of six pregnancies. Eur J Obstet Gynecol Reprod Biol 2003; 111: 146–52.Google Scholar
Gordon, LI, Kwaan, HC, Rossi, EC. Deleterious effects of platelet transfusions and recovery thrombocytosis in patients with thrombotic microangiopathy. Semin Hematol 1987; 24: 194201.Google Scholar
Nester, CM, Thomas, CP. Atypical hemolytic uremic syndrome: what is it, how is it diagnosed, and how is it treated? Hematology Am Soc Hematol Educ Program 2012; 2012: 617–25. http://asheducationbook.hematologylibrary.org/content/2012/1/617.full (accessed March 2017).Google Scholar
Taylor, CM, Machin, S, Wigmore, S, Goodship, TH; Renal Association, British Committee for Standards in Haematology, British Transplantation Society. Clinical practice guidelines for the management of atypical haemolytic uraemic syndrome in the United Kingdom. Br J Haematol 2010; 148: 3747. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2009.07916.x/epdf (accessed March 2017).Google Scholar
Kavanagh, D, Goodship, TH, Richards, A. Atypical haemolytic uraemic syndrome. Br Med Bull 2006; 77–78: 522.Google Scholar
Fang, CJ, Richards, A, Liszewski, MK, et al. Advances in understanding a pathogenesis of AHUS and HELLP. Br J Haematol 2008; 143: 336–48.CrossRefGoogle ScholarPubMed
Fakhouri, F, Roumenina, L, Provot, F, et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 21: 859–67.Google Scholar
Cañigral, C1, Moscardó, F, Castro, C, et al. Eculizumab for the treatment of pregnancy-related atypical hemolytic uremic syndrome. Ann Hematol 2014; 93: 1421–2.Google Scholar
Loguidice, C. Does eculizumab play a role in treating pregnancy-associated atypical hemolytic–uremic syndrome? Rare Disease Report 2014. http://www.raredr.com/news/Eculizumab-Pregnancy-AssociatedaHUS (accessed March 2017).Google Scholar
Knight, M, Nelson-Piercy, C, Kurinczuk, JJ, Spark, P, Brocklehurst, P; UK Obstetric Surveillance System. A prospective national study of acute fatty liver of pregnancy in the UK. Gut 2008; 57: 951–6.Google Scholar
Royal College of Obstetricians and Gynaecologists. Management of Inherited Bleeding Disorders in Pregnancy. Green-top Guideline No. 71. London: RCOG, 2017. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg71 (accessed September 2019)Google Scholar
Laffan, MA, Lester, W, O’Donnell, JS, et al. The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology. Br J Haematol 2014; 167: 453–65. http://onlinelibrary.wiley.com/doi/10.1111/bjh.13064/epdf (accessed March 2017).Google Scholar
Rodeghiero, F, Castaman, G, Dini, E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood 1987; 69: 454–9.Google Scholar
Bloom, AL. von Willebrand factor: clinical features of inherited and acquired disorders. Mayo Clin Proc 1991; 66: 743–51.Google Scholar
Lillicrap, D, James, P. von Willebrand Disease: an Introduction for the Primary Care Physician. Treatment of Haemophilia No. 47. Montreal: World Federation of Hemophilia, 2009. http://www1.wfh.org/publication/files/pdf-1204.pdf (accessed March 2017).Google Scholar
Tosetto, A, Rodeghiero, F, Castaman, G, et al. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost 2006; 4: 766–73.Google Scholar
Rodeghiero, F, Castaman, G, Tosetto, A. How I treat von Willebrand disease. Blood 2009; 114: 1158–65.Google Scholar
Ranger, A, Manning, RA, Lyall, H, Laffan, MA, Millar, CM. Pregnancy in type 2B VWD: a case series. Haemophilia 2012; 18: 406–12.Google Scholar
Giles, AR, Hoogendoorn, H, Benford, K. Type IIB von Willebrand’s disease presenting as thrombocytopenia during pregnancy. Br J Haematol 1987; 67: 349–53.Google Scholar
Rick, ME, Williams, SB, Sacher, RA, et al. Thrombocytopenia associated with pregnancy in a patient with type IIB von Willebrand’s disease. Blood 1987; 69: 786–9.Google Scholar
James, AH, Jamison, MG. Bleeding events and other complications during pregnancy and childbirth in women with von Willebrand disease. J Thromb Haemost 2007; 5: 1165–9.Google Scholar
Lutomski, J, Byrne, B, Devane, D, Greene, R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG 2012; 119: 306–14.Google Scholar
Carroli, G, Cuesta, C, Abalos, E, Gulmezoglu, AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22: 9991012.Google Scholar
Kujovich, JL. von Willebrand disease and pregnancy. J Thromb Haemost 2005; 3: 246–53.CrossRefGoogle ScholarPubMed
Conti, M, Mari, D, Conti, E, et al. Pregnancy in women with different types of von Willebrand disease. Obstet Gynecol 1986; 68: 282–5.Google Scholar
Kirtava, A, Drews, C, Lally, C, Dilley, A, Evatt, B. Medical reproductive and psychosocial experiences of women diagnosed with vWD receiving care in haemophilia treatment centres: a case–control study. Haemophilia 2003; 9: 292–7.Google Scholar
James, AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia 2005; 11: 295307.Google Scholar
Lak, M, Peyvandi, F, Mannucci, PM. Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease. Br J Haematol 2000; 111: 1236–9.Google Scholar
Lee, CA, Chi, C, Pavord, SR, et al. The obstetric and gynaecological management of woman with inherited bleeding disorders. Haemophilia 2006; 12: 301–36.Google Scholar
Kadir, RA, Lee, CA, Sabin, CA, et al. Pregnancy in women with von Willebrand’s disease or factor XI deficiency. Br J Obstet Gynaecol 1998; 105: 314–21.Google Scholar
Kouides, PA. Obstetric and gynaecological aspects of vWD. Ballieres Best Pract Clin Haematol 2001; 14: 381–99.Google Scholar
Federici, AB, Mannucci, PM. Diagnosis and management of von Willebrand disease. Haemophilia 1999; 5 (Suppl 2): 2837.Google Scholar
Mannucci, PM. How I treat patients with von Willebrand’s disease. Blood 2001; 97: 1915–19.CrossRefGoogle Scholar
Ray, JG. DDAVP use during pregnancy: an analysis of its safety for mother and child. Obstet Gynecol Surv 1998; 53: 450–5.Google Scholar
Mannucci, PM. Use of desmopressin (DDAVP) during early pregnancy in factor VIII deficient women. Blood 2005; 105: 3382.Google Scholar
Sanchez-Luceros, A, Meschengieser, SS, Turdo, KL, et al. Evaluation of the clinical safety of desmopression during pregnancy in woman with a low plasmatic von Willebrand factor level and bleeding history. Thromb Res 2007; 120: 387–90.Google Scholar
Goudemard, J, Negrier, C, Ounnoughene, O, Sultan, Y. Clinical management of patients with vWD with a VHP VWF concentrate: the French experience. Haemophilia 1998; 4: 4852.Google Scholar
Varughese, J, Cohen, AJ. Experience with epidural anaesthesia in pregnant women with von Willebrand disease. Haemophilia 2007; 13: 730–3.Google Scholar
TSE Working Group of the HPA. TSE Agents: Safe Working and Prevention of Infection. Part 4: Infection Control of CJD and Related Disorders in the Healthcare Setting. London: Health Protection Agency, 2007.Google Scholar
TSE Working Group of the Health Protection Agency. Distribution of the TSE Infectivity in Human Tissues and Body Fluids, Annex A1 of Safe Working and Prevention of Infection. London: Health Protection Agency, 2008.Google Scholar
Andrew, M, Paes, B, Milner, R, et al. Development of the human coagulation system in the full-term infant. Blood 1987; 70: 165–72.Google Scholar
Smith, TJ, Gill, JC, Ambruso, DR, Hathaway, WE. Hyponatremia and seizures in young children given DDAVP. Am J Hematol 1989; 31: 199202.Google Scholar
Keeling, D, Tait, C, Makris, M. Guideline on the selection and use of therapeutic products to treat haemophilia and other hereditary bleeding disorders. Haemophilia 2008; 14: 671–84. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2516.2008.01695.x/epdf (accessed March 2017).Google Scholar
Bolton-Maggs, PH, Pasi, JK. Haemophilias A and B. Lancet 2003: 361; 1801–9.Google Scholar
Lyon, MF. X-Chromosome Inactivation. In Encyclopedia of Molecular Medicine, 2002.Google Scholar
Giannelli, F, Green, PM. The molecular basis of haemophilia A and B. Baillieres Clin Haematol 1996; 9: 211–28.Google Scholar
Plug, I, Mauser-Bunschoten, EP, Bröcker-Vriends, AH, et al. Bleeding in carriers of hemophilia. Blood 2006; 108: 52–6.Google Scholar
Chi, C, Lee, CA, Shiltagh, N, Khan, A, Pollard, D, Kadir, RA. Pregnancy in carriers of haemophilia. Haemophilia 2008; 14: 5664.Google Scholar
Ljung, RC. Intracranial haemorrhage in haemophilia A and B. Br J Haematol 2008; 140: 378–84.Google Scholar
Ludlam, CA, Pasi, KJ, Bolton-Maggs, P, et al.; UKHCDO Genetics Working Party. Clinical genetics services for haemophilia. Haemophilia 2005; 11: 145–63.Google Scholar
Mitchell, M, Keeney, S, Goodeve, A. The molecular analysis of haemophilia B: a guideline from the UK Haemophilia Centre Doctors Organisation, Haemophilia Genetics Laboratory Network. Haemophilia 2005; 11: 398404.Google Scholar
Naylor, J, Brinke, A, Hassock, S, et al. Characteristic mRNA abnormality found in half of the patients with severe haemophilia A is due to large DNA inversions. Hum Mol Genet 1993; 11: 1773–8.Google Scholar
Manucci, PM. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood 1997; 90: 2515–21.Google Scholar
Miller, R. Counselling about diagnosis and inheritance of genetic bleeding disorders: haemophilia A and B. Haemophilia 1999; 5: 7783.Google Scholar
Giangrande, PLF. Management of pregnancy in carriers of haemophilia. Haemophilia 1998; 4: 779–84.Google Scholar
Efrat, Z, Perri, T, Ramati, E, Tugendreich, D, Meizner, I. Fetal gender assignment by first-trimester ultrasound. Ultrasound Obstet Gynecol 2006; 27: 619–21.Google Scholar
Chi, C, Hyett, JA, Finning, KM, et al. Noninvasive first trimester determination of foetal gender: a new approach for pre-natal diagnosis of haemophilia. BJOG 2006; 113: 239–42.Google Scholar
Ren, CC, Miao, XH, Cheng, H, et al. Detection of fetal sex in the peripheral blood of pregnant women. Fetal Diagn Ther 2007; 22: 377–82.Google Scholar
Santacroce, R, Vecchione, G, Tomaiyolo, M, et al. Identification of fetal gender in maternal blood is a helpful tool in the prenatal diagnosis of haemophilia. Haemophilia 2006; 12: 417–22.Google Scholar
Mujezinovic, F, Alfirevic, Z. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol 2007; 110: 687–94.Google Scholar
Picone, O, Senat, MV, Rosenblatt, J, et al. Fear of pregnancy loss in fetal karyotyping: A place for third trimester amniocentesis? Fetal Diagn Ther 2008; 23: 30–5.Google Scholar
Tsui, NB, Kadir, RA, Chan, KC, et al. Noninvasive prenatal diagnosis of hemophilia by microfluidics digital PCR analysis of maternal plasma DNA. Blood 2011; 117: 3684–91.Google Scholar
Buscaglia, M, Ghisoni, L, Bellotti, M, et al. Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years’ experience. Fetal Diagn Ther 1996; 11: 106–13.Google Scholar
Econamides, DL, Kadir, RA, Braithwaite, JM, et al. The obstetric experience of carriers of haemophilia. Br J Obstet Gynaecol 1997; 104: 803–10.Google Scholar
Ljung, R, Lindgren, AC, Petrini, P, et al. Normal vaginal delivery is to be recommended for haemophilia carrier gravidae. Acta Paediatr 1994; 83: 609–11.Google Scholar
Kulkarni, R, Lusher, J. Perinatal management of newborns with haemophilia. Br J Haematol 2001; 112: 264–74.Google Scholar
Lorenzo, JI, Lopez, A, Altisent, C, Asnar, JA. Incidence of factor VIII inhibitors in severe haemophilia: the importance of patient age. Br J Haematol 2001; 113: 600–3.Google Scholar
Levi, M, Toh, CH, Thachil, J, Watson, HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol 2009; 145: 2433. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2009.07600.x/epdf (accessed March 2017).Google Scholar
Giles, AR. Disseminated intravascular coagulation. In Bloom, AL, Forbes, CD, Thomas, DP, Taddenham, EGD (eds), Haemostasis and Thrombosis, 3rd edn, vol. 2. Edinburgh: Churchill Livingstone, 1994.Google Scholar
Levi, M, TenCate, H. Disseminated intravascular coagulation. N Engl J Med 1999; 341: 586–92.Google Scholar
Toh, CH, Hoots, WK. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a five year overview. J Thromb Haemost 2007; 5: 604–6.Google Scholar
Johansson, PI, Stissing, T, Bochsen, L, Ostrowski, SR. Thrombelastography and tromboelastometry in assessing coagulopathy in trauma. Scand J Trauma Resusc Emerg Med 2009; 17: 45.Google Scholar
Girdauskas, E, Kempfert, J, Kuntze, T, et al. Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. J Thorac Cardiovasc Surg 2010; 140: 1117–24.Google Scholar
National Institute for Health and Care Excellence. Detecting, Managing and Monitoring Haemostasis: Viscoelastometric Point-of-Care Testing (ROTEM, TEG and Sonoclot systems). Diagnostics Guidance DG13. London: NICE, 2014. https://www.nice.org.uk/guidance/dg13 (accessed March 2017).Google Scholar
Charbit, B, Mandelbrot, L, Samain, E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5: 266–73. doi:10.1111/j.1538–7836.2007.02297.x.Google Scholar
Thachil, J, Toh, CH, Levi, M, Watson, HG. The withdrawal of activated protein C from the use in patients with severe sepsis and DIC [Amendment to the BCSH guideline on disseminated intravascular coagulation]. Br J Haematol 2012; 157: 493–4. doi: 10.1111/j.1365–2141.2011.09019.Google Scholar
Stainsby, D, MacClennan, S, Thomas, D, et al. Guidelines on the management of massive blood loss. Br J Haematol 2006; 135: 634–41.Google Scholar
Ferrer, P, Roberts, I, Sydenham, E, Blackhall, K, Shakur, H. Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC Pregnancy Childbirth 2009; 9: 29.Google Scholar
O’Connell, NM, Perry, DJ, Hodgson, AJ, et al. Recombinant factor VIIa in the management of uncontrolled haemorrhage. Transfusion 2003; 43: 1649–51Google Scholar
Moscardo, F, Perez, F, de la Rubia, J, et al. Successful treatment of severe intra-abdominal bleeding associated with disseminated intravascular coagulation using recombinant activated factor VII. Br J Haematol 2001; 114: 174–6.Google Scholar
Kadir, RA, Davies, J. Hemostatic disorders in women. J Thromb Haemost 2013; 11 (Suppl. 1): 170–9.Google Scholar
Tripodi, A, Mannucci, PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147–56.Google Scholar
Kalina, U, Bickhard, H, Schulte, S. Biochemical comparison of seven commercially available prothrombin complex concentrates. Int J Clin Pract 2008; 62: 1614–22.Google Scholar
Lorenz, R, Kienasi, J, Otto, U, et al. Efficacy and safety of a prothrombin complex concentrate with two virus inactivation steps in patients with severe liver damage. Eur J Gastroenterol Hepatol 2003; 15: 1520.Google Scholar
Collins, PW, Chalmers, E, Hart, DP, et al. Diagnosis and treatment of factor VIII and IX inhibitors in congenital haemophilia (4th edition). UK Haemophilia Centre Doctors Organization. Br J Haematol 2013; 160: 153–70. http://onlinelibrary.wiley.com/doi/10.1111/bjh.12091/epdf (accessed March 2017).Google Scholar
Giangrande, P. Acquired Haemophilia, revised edn. Treatment of Haemophilia No. 38. Montreal: World Federation of Hemophilia, 2012. http://www1.wfh.org/publication/files/pdf-1186.pdf (accessed March 2017).Google Scholar
Hauser, I, Schneider, B, Lechner, K. Post-partum factor VIII inhibitors: a review of the literature with special reference to the value of steroid and immunosuppressive treatment. Thromb Haemost 1995; 73: 15.Google Scholar
Coller, BS, Hultin, MB, Hoyer, LW, et al. Normal pregnancy in a patient with a prior postpartum factor VIII inhibitor: with observations on pathogenesis and prognosis. Blood 1981; 58: 619–24.Google Scholar
Franchini, M, Zaffanello, M, Lippi, G. Acquired hemophilia in pediatrics: a systematic review. Pediatr Blood Cancer 2010; 55606611. doi: 10.1002/pbc.2265.Google Scholar

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