title: Therapeutic apheresis in pregnancy: General considerations and current practice.
abstract: It is widely known that pregnancy does not represent a contraindication to therapeutic apheresis (TA) techniques. In fact, since the first experiences of TA in pregnancy for the prevention of hemolytic disease of the newborn, several diseases are at present treated with TA, mainly within 6 clinical categories: (a) TA is a priority and has no alternative equally effective treatment (e.g., thrombotic thrombocytopenic purpura); (b) TA is a priority but there are alternative therapies not contraindicated in pregnancy (e.g., myasthenia gravis); (c) TA is an effective tool of saving/avoiding drugs contraindicated in pregnancy (e.g., systemic lupus erythematosus); (d) TA is a treatment of specific conditions/complications of pregnancy with maternal and/or fetal risk (e.g., antiphospholipid syndrome); (e) TA is a treatment of specific conditions of pregnancy with exclusive fetal risk (e.g., hemolytic disease of the newborn); (f) TA is a treatment of disease which is strongly indicated and can exceptionally occur during pregnancy (e.g., Goodpasture's syndrome). When dealing with TA pregnant patients, some technical aspects due to the physiological changes of gestation have to be carefully considered, in particular the increase of the circulating blood volume. Moreover a multidisciplinary medical team, including an obstetrician, a clinical consultant, specialist in TA and in transfusion medicine, and a neonatologist stand as a basic requirement for the proper management of some clinical conditions that may be characterized by high maternal and fetal risk.
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy. Electronic address: piero.marson@sanita.padova.it.
authors.forename: Piero
authors.initials: P
authors.lastname: Marson
authors.affiliation: Obstetrics and Gynecology Unit, Department for Health of Woman and Child, University Hospital of Padua, Padua, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gervasi
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tison
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Colpo
authors.affiliation: Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
authors.forename: Giustina
authors.initials: G
authors.lastname: De Silvestro
mesh_terms: D001781:Blood Component Removal / Q000379:methods*; D004899:Erythroblastosis, Fetal / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*
keywords: ASFA guidelines; Hemolytic disease of the newborn; Pregnancy; Therapeutic apheresis