Zhonghua Xue Ye Xue Za Zhi. 2026 Feb 14;47(2):160-165. doi: 10.3760/cma.j.cn121090-20250723-00345.
ABSTRACT
Objective: To evaluate whether the physiological hypercoagulable state of pregnancy affects the risk and severity of bleeding in pregnant patients with immune thrombocytopenia (ITP) and severe thrombocytopenia (PLT<20×10(9)/L) , compared to non-pregnant ITP patients with a comparable degree of thrombocytopenia. Methods: We retrospectively reviewed the data of pregnant patients with ITP who were hospitalized at the Second Affiliated Hospital of Kunming Medical University between January 1, 2013, and April 30, 2024, excluding patients with secondary thrombocytopenia due to pathological pregnancy. Non-pregnant ITP patients were matched as a control group at a 1∶2 ratio based on three criteria (age, ITP disease duration, and nadir PLT) , after which bleeding events and severity were compared between the two groups. Results: A total of 23 pregnant ITP patients with a PLT<20×10(9)/L during pregnancy were included and matched to 46 non-pregnant ITP patients. Pregnant ITP patients had significantly shorter activated partial thromboplastin time (APTT) and prothrombin time (PT) than non-pregnant ITP patients (both P<0.05) . No statistically significant differences were found between the pregnant and non-pregnant ITP groups in the incidence of bleeding events (73.9% vs 89.1% , P=0.161) or in their overall bleeding score (P=0.072) . In the pregnant ITP group, the maximum bleeding score was 5, occurring in only 2 cases, 8.7% , while 91.3% of cases had a bleeding score of ≤3. In the non-pregnant ITP group, 3 patients (6.5% ) experienced life-threatening major bleeding (maximum score: 8) , comprising 1 case of hemorrhagic shock and 2 cases of cerebral hemorrhage, one of which was fatal. Additionally, 19.6% of patients in this group had a bleeding score of 5, and 73.9% had a score of ≤3. The incidence of bleeding events with a score of ≥5 was three times higher in the non-pregnant group than in the pregnant group (26.1% vs 8.7% ) . Conclusion: Pregnant patients with ITP, even those with a PLT count <20×10(9)/L, have a lower incidence of severe bleeding compared to non-pregnant ITP patients with a comparable degree of thrombocytopenia; furthermore, they exhibit shorter APTT and PT, suggesting that the relative hypercoagulable state during pregnancy may be the potential reason for the reduced bleeding severity in these patients.
PMID:41839630 | DOI:10.3760/cma.j.cn121090-20250723-00345