Manajemen Anestesi pada Seksio Sesarea dengan Idiopathic Thrombocytopenic Purpura: Serial kasus
Abstract
Trombositopenia merupakan perubahan hemostasis yang umum terjadi pada wanita hamil, namun jarang ditemukan kondisi berat. Idiopathic thrombocytopenic purpura (ITP) merupakan salah satu penyebab trombositopenia pada wanita hamil. ITP ditandai dengan peningkatan penghancuran trombosit oleh antibodi immunoglobulin G (IgG) yang dapat meningkatkan risiko perdarahan pada pasien dan fetus. Kami melaporkan tiga kasus wanita hamil dengan ITP yang akan dilakukan tindakan seksio sesarea. Satu pasien menjalani seksio sesarea emergency dengan trombosit 4000 dan dua pasien menjalani seksio sesarea elektif. Pasien seksio sesarea elektif diberikan transfusi trombosit perioperatif terlebih dahulu. Ketiga pasien menjalani prosedur seksio sesarea dengan teknik anestesi general. Pemantauan perdarahan dilakukan selama sampai dengan setelah operasi. Kondisi postoperatif pasien baik dan dirawat di ruang intensive care unit (ICU).
Case Series: Anesthesia Management in Caesarean Section with Idiopathic Thrombocytopenic Purpura
Abstract
Thrombocytopenia is the most common hemostatic change in pregnancy, but severe thrombocytopenia is rare. One of the causes, idiopathic thrombocytopenic purpura (ITP), is characterized by increased platelet destruction by immunoglobulin G (IgG) antibodies, presenting a high risk of hemorrhage for the patient, but also the fetus, since antibodies may cross the placenta. We report three cases of pregnant women with ITP undergoing cesarean section. One patient underwent emergency cesarean section with a platelet of 4000 and two patients underwent elective cesarean. Patients with elective cesarean section were given the first perioperative platelet transfusion. The cesarean section procedures were performed under general anesthesia. Bleeding monitoring is carried out during up to after surgery.
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References
Davis LA. Anesthetic considerations for the parturient with immune thrombocytopenic purpura. Nursing Capstones. 2018: 169. Accessed December 2, 2020.
Ozbilgin S, Balkan BK, & Sasmaz B. Anesthesia for caesarean section of pregnant women with idiopathic thrombocytopenic purpura. Turk J Anaesth Reanim. 2013; 41: 175–7.
Suparna M, Rudra AP, & Jyotsna G. Anesthesia management of patient with idiopathic thrombocytopenic purpura – a case series. J Anesth Ther. 2018; (1): 105. Accessed December 2, 2020.
Jamal S, Goel N, Mehta A, & Ahuja M. Recurrent severe gestational thrombocytopenia in pregnancy: a case report. Int J Adv Med. 2017; 4(6): 1702 – 1705.
Sumathy V, Devi C, & Padmanaban S. Prospective study of thrombocytopenia in pregnancy. International Journal of Clinical Obstetric and Gynaecology. 2019; 3(1): 17 – 21.
Amorim JG, Abecasis MR, & Rodrigues FM. Refractory severe thrombocytopenia during pregnancy: how to manage. Rev Bras Ginecol Obstet. 2018; 40: 803 – 807.
Yan M, Malinowski AK, & Shehata N. Thrombocytopenic Syndromes in Pregnancy. Obstetric Medicine. 2016; 9(1): 15–20.
Becocci A, Civitillo CF, Laurent M, Boehlen F, Luca R, & Fluss J. Intracranial hemorrhage and autoimmune thrombocytopenia in a neonate: a rare unpredictable event. Child Neurology Open. 2018; 5: 1–5.
Nazeer RM, & Patil MA. Thrombocytopenia in pregnancy and its correlation with maternal and fetal outcome. Journal of Critical Review. 2020; 7(12).
Izak, M, Bussel J. Management of thrombocytopenia F1000Prime Reports. 2014; 6.
Fadiloglu E, Unal C, Tanacan A, Portakal O, Beksac MS. 5 years’ experience of a tertiary center with thrombocytopenic pregnancies: Gestational thrombocytopenia, idiopathic thrombocytopenic purpura and hypertensive disorders of pregnancy. Geburtshilfe Frauenheilkd. 2020;80(1):76–83.
Straube LE, de Ridder GG, Huber CA, Blacker SN. Spinal anesthetic in a patient with a platelet count of 7000 × 109/L and undiagnosed thrombotic thrombocytopenic Purpura: A case report: A case report. A A Pract. 2020;14(6):e01184
Neunert CE, Cooper N. Evidence-based management of immune thrombocytopenia: ASH guideline update. Hematology Am Soc Hematol Educ Program 2018;568–75.
RACP: The Haematology Society of Australia and New Zealand top 5 Evolve low-value practices and interventions. Sydney, NSW: RACP, 2015 September [cited 2019 Jan 30]; Available from: https://evolve.edu.au/published-lists/hsanz/
Rajasekhar A, Gernsheimer T, Stasi R, James AH. 2013 Clinical practice guide on thrombocytopenia in pregnancy. Washington, DC: American Society of Hematology;2013 cited 2019 Jan 31. Available from. http://www.hematology.org/Clinicians/GuidelinesQuality/Quick-Reference.aspx.
Eslick R, McLintock C. Managing ITP and thrombocytopenia in pregnancy. Platelets. 2020;31(3):300–6.
Care A, Pavord S, Knight M, Alfirevic Z. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study. Br J Obstet Gynaecol 2018;125:604–612.
Gilmore KS, McLintock C. Maternal and fetal outcomes of primary immune thrombocytopenia during pregnancy: A retrospective study. Obstet Med 2018;11:12–16.