Pregnancy following splenectomy due to ITP

Thanks for taking the time to read my question

I have had two children since being diagnosed with ITP; following the children my platelets were still heading south so I had a splenectomy which has since improved and stabilised my platelet count.

My question is - has anyone here been pregnant following a splenectomy, and are they aware of any complications? I wonder if I should expect my platelet count to drop again, if there is a risk of a reduced platelet count in the baby or anything else that may have been directly attributed to the removal of the spleen?
And... if there was a reduction in your platelets due to the pregnancy, did they rebound up again after the birth?

I haven't discussed with my haematologist yet as I'm not sure if we'll go ahead with it... so this may help in my decision as to whether we go ahead with trying again or not...

Thanks for your help!

Cupcake_Ange wrote: I wonder ... if there is a risk of a reduced platelet count in the baby or anything else that may have been directly attributed to the removal of the spleen?
...

There are many studies on pregnancy outcomes with ITP, if you are interested. Here are a few:

In a quite recent study of 40 newborn infants born to 40 mothers with ITP, 15 neonates had platelets lower than 150k, and 8 had platelets lower than 50k. "There was statistically significant association between neonatal thrombocytopenia and maternal splenectomy history and maternal duration of thrombocytopenia." However, at least from the abstract, it appears that long term outcomes were not studied, that is, whether the neonatal thrombocytopenia persisted or not, so bear that in mind.

link.springer.com/article/10.1007/s12288-016-0708-5
Neonatal Outcomes of Pregnancy with Immune Thrombocytopenia

An older and smaller study showed similar results, but also noted, "However, in our study, we found that thrombocytopenia persisted in infants born to mothers with positive antiplatelet autoantibodies compared with those lacking these antibodies." Do you know whether you test positive for antiplatelet antibodies? It may be worth testing for.

www.nature.com/jp/journal/v30/n1/full/jp2009134a.html
Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura

Here is a very new, very large multi-center USA study that has data on birth defects for children born to mothers with ITP:

www.hindawi.com/journals/jp/2016/8297407/
Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura
5. Conclusion

Based on the evaluation of 446 pregnant women with ITP, a diagnosis of ITP or cITP prior to their estimated date of conception may indicate a higher risk for stillbirth or fetal loss, premature delivery, and infants with specific congenital anomalies than an ITP diagnosis during pregnancy. Therefore, the results of this study provide further evidence that the duration of maternal ITP may be an important determinant of the outcomes of pregnancy.

Hello. Yes, a pregnancy could end a remission but a cold can too, so you never know what might happen. It's also highly possible that your counts will be just fine.

Yes, the baby could be born with low platelets because you may still have anti-platelet antibodies. But the baby's counts should rebound in a few days.

Thanks guys - I have dealt with ITP and pregnancy with my two children.
The difference now is that I have had a splenectomy, and am wondering if the splenectomy will facilitate any difference in platelets or anything else... but I'm having trouble finding any info about this

This is my thought: Your chances of retaining higher counts throughout pregnancy might be greater than before, but there is no guarantee. The only real difference between now and then is that you have a good remission going now that could last.

This study claims to show prior splenectomy to be a risk factor for preterm delivery, roughly doubling the risk:

www.ncbi.nlm.nih.gov/pubmed/21732739
Pregnancy outcome in women following splenectomy.
"splenectomy was found to be an independent risk factor for preterm delivery (OR 2.1, 95% CI 1.4-3.3, p=0.001)."

Some useful information for pregnant asplenic women:

www.mvec.vic.edu.au/wp-content/uploads/2015/01/Patient-information-sheet-for-pregnant-or-breastfeeding-women-with-asplenia-or-hyposplenism.pdf
Information for pregnant or breastfeeding women who have asplenia or hyposplenism
**Patient information sheet**