title: Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome.
abstract: Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non-pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. We report three successfully treated patients throughout pregnancy, for differential indications: thrombotic thrombocytopenic purpura, red blood cells alloimmunization and ulcerative colitis. Multiple courses of TA have been performed without any complications for the mother and the fetus. A review and a discussion on the particular TA implications related to maternal-fetal medicine have been reported. When approaching TA in pregnancy, clinicians have to consider the severity of disease, the strength of the indications, and the gestational age. Each case must be evaluated individually on the basis of existing evidence since, despite the increasing use, specific guidelines for apheresis in pregnancy are still lacking.
authors.affiliation: Department of Obstetrical and Gynecological Sciences and Urological Sciences.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Perrone
authors.affiliation: Department of Obstetrical and Gynecological Sciences and Urological Sciences.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brunelli
authors.affiliation: Department of Obstetrical and Gynecological Sciences and Urological Sciences.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Marcoccia
authors.affiliation: Department of Obstetrical and Gynecological Sciences and Urological Sciences.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Zannini
authors.affiliation: Department of Obstetrical and Gynecological Sciences and Urological Sciences.
authors.forename: Miriam
authors.initials: M
authors.lastname: Candelieri
authors.affiliation: Immunohematology and Transfusion Medicine.
authors.forename: Maria
authors.initials: M
authors.lastname: Gozzer
authors.affiliation: Extracorporeal Therapeutic Techniques Unit, Immunohematology and Transfusion Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, 'Umberto I' Hospital, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Stefanutti
mesh_terms: D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D003093:Colitis, Ulcerative / Q000628:therapy*; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy*; D016896:Treatment Outcome
keywords: Pregnancy; Red cell alloimmunization; Therapeutic apheresis; Thrombotic thrombocytopenic purpura; Ulcerative colitis