Therapeutic plasma exchange in pregnancy: A literature review
European journal of obstetrics, gynecology, and reproductive biology. 2021;260:29-36
Therapeutic plasma exchange (TPE) is indicated as a treatment for a wide array of diseases, extensively addressed in the Guidelines of the American Society for Apheresis. In pregnancy, TPE is an uncommon event and application is largely based on extrapolation of efficacy and safety in a non-pregnant population. This review intends to describe the currently available experience of TPE in pregnancy to help clinicians recognise indications during pregnancy and to support current guideline recommendations with literature-based experiences. In order to identify the clinical indications for which TPE is applied in pregnant women, we performed a literature search including studies till November 2019, without a start date restriction. Data extraction included medical indication for TPE and safety of TPE in pregnant women. 279 studies were included for analysis. Nowadays, TPE is predominantly applied for thrombotic microangiopathies, lipid disorders and a variety of autoimmune diseases. The application of TPE during pregnancy remains largely empiric and relies on individual case reports in the absence of high-quality studies and definitive evidence-based guidelines. Safety profile of TPE during pregnancy appears to be comparable to application of TPE in non-pregnant patients. In conclusion, based on the limited evidence that we found in literature with a high risk of publication bias, TPE procedures can be used safely during pregnancy with the appropriate preparation and experience of a multidisciplinary team.
The effects of exchange transfusion for prevention of complications during pregnancy of sickle hemoglobin C disease patients
BACKGROUND Pregnancy represents a challenge for women with sickle cell disease (SCD), with higher rates of both maternal and fetal complications. The aim of this study was to evaluate the impact of prophylactic transfusion support administered specifically to pregnant women with sickle hemoglobin C disease. MATERIALS AND METHODS Patients were divided into two groups according to the type of transfusion support received: 10 women received prophylactic erythrocytapheresis or manual exchange transfusion at 28 weeks of gestation, and 14 received transfusions only on demand, due to acute complications, or received no transfusions at all. RESULTS Our results indicated higher frequencies of SCD-related complications in the group that did not receive prophylactic transfusion support (35.7% vs. only 10% in the erythrocytapheresis group). Furthermore, these complications were more severe in this group and included all cases of acute chest syndrome. A significant difference was observed concerning gestational age at birth (38.7 weeks in the transfusion group vs. 34.4 weeks, p=0.037), with a higher frequency of preterm births in the nontransfused group (69.23% vs. 30% in the transfusion group). CONCLUSION We demonstrated a clear reduction of unfavorable outcomes in patients receiving prophylactic transfusions, probably reflecting better maternal and fetal conditions, which corroborated to the more satisfactory indices of vitality, observed in newborns. Considering that erythrocytapheresis or manual exchange transfusions both represent feasible and safe procedures, they could represent important tools for the optimal management of these patients.Copyright 2015 AABB.
Iron supplementation during pregnancy--experiences of a randomized trial relying on health service personnel
Controlled Clinical Trials. 1989;10((3):):290-8.
This article reports the design and feasibility of a randomized controlled trial of the benefits of routine iron prophylaxis during pregnancy. The multicenter trial, supported by a small budget, relied on health service personnel in Finnish maternity centers. Iron prophylaxis has had an established position in Finnish maternity care, and iron is freely available. This contributed to our decision to ask for informed consent after randomization. During a year, 2960 mothers were recruited by midwives in 27 maternity health centers and randomized into two groups: selective and routine iron supplementation. Mothers were followed until the postpartum checkup, and data were collected by five different questionnaires and abstracted from the infant's patient record. Adherence of the midwives to the study protocol was satisfactory, as was mothers' compliance with recommended treatments. However, because the study was designed to compare two treatment policies, problems of nonmasking hamper of the biologic effects of iron. This trial encourages the use of existing health services and their personnel in evaluation of medical technology.
Maternal zinc during oral iron supplementation in pregnancy: a preliminary study
Clinical Science. 1989;76((1):):59-65.
1. To investigate the possible effect of iron ingestion on maternal zinc status, one group of women was given 94 mg of iron per day as ferrous sulphate with multivitamins during the second and third trimesters of their pregnancies and another, control, group was given a placebo of multivitamins without iron. 2. The subjects given iron developed significantly lower plasma zinc concentrations than those in the control group. This effect on zinc was maximal by 6 weeks, whilst that on maternal iron status was slower. 3. There was no parallel decrease of zinc concentration in maternal mixed leucocytes, or of plasma heatlabile alkaline phosphatase activity, suggesting that there was a redistribution of zinc between plasma and tissues. 4. The results indicate that iron supplementation during pregnancy alters the disposition of zinc in the mother.