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Anti‐platelet factor 4 immunothrombotic syndromes comprise a group of disorders that include heparin‐induced thrombocytopenia and vaccine‐induced immune thrombocytopenia and thrombosis. These are highly prothrombotic, immunological disorders characterised by specific clinical and pathological criteria which include thrombocytopenia and thrombosis. While they are predominantly triggered by heparin and the adenoviral vector vaccines, respectively, other provoking factors have been described, as well as spontaneous forms. The unexplained co‐occurrence of thrombocytopenia with thrombosis should raise suspicion and prompt testing. This nutshell review discusses the pathophysiology, presenting features and diagnostic criteria for these conditions. [ABSTRACT FROM AUTHOR]

Summary: Many medications have been reported to be associated with thrombotic thrombocytopenic purpura (TTP) through pharmacovigilance data and published case reports. Whilst there are existing data available regarding drug‐induced thrombotic microangiopathy, there is no available synthesis of evidence to assess drug‐induced TTP (DI‐TTP). Despite this lack of evidence, patients with TTP are often advised against using many medications due to the theoretical risk of DI‐TTP. This systematic review evaluated the evidence for an association of medications reported as potential triggers for TTP. Of 5098 records available 261 articles were assessed further for eligibility. Fifty‐seven reports, totalling 90 patients, were included in the final analysis. There were no cases where the level of association was rated as definite or probable, demonstrating a lack of evidence of any drug causing DI‐TTP. This paucity of evidence was also demonstrated in the pharmacovigilance data, where 613 drugs were reported as potential causes of TTP without assessment of the strength of association. This systematic review demonstrates the need for standardised reporting of potential drugs causing TTP. Many reports omit basic information and, therefore, hinder the chance of finding a causative link if one exists. [ABSTRACT FROM AUTHOR]

Those with moderate-to-severe anaemia (haemoglobin <100 g/l), with late gestation (referred >36 weeks), or symptomatic of anaemia (fatigue, palpitations) were prescribed IV iron as they were considered to have insufficient time before delivery for oral iron to be effective. While IV iron produced a faster haemoglobin rise than oral iron, with careful selection of best treatment we achieved similar haemoglobin concentrations at delivery regardless of the route of iron administration. Keywords: anaemia; iron deficiency; pregnancy; oral iron; IV iron EN anaemia iron deficiency pregnancy oral iron IV iron 445 448 4 01/17/22 20220115 NES 220115 Anaemia is highly prevalent during pregnancy, estimated at 23% of pregnant women in the UK.1 Demands for iron from the developing fetus, expanding maternal haemoglobin mass, and blood loss at delivery2 frequently outstrips supply from maternal iron stores. [Extracted from the article]

Summary: The COVID‐19 pandemic has created many challenges in the management of immune thrombocytopenic purpura (ITP). The recommendation for avoidance of steroids by WHO led to the off‐licence use, supported by NHS England, of thrombopoietin mimetics (TPO‐RA) for newly diagnosed or relapsed ITP. This is a real‐world prospective study which investigated the treatment patterns and outcomes in this setting. Twenty‐four hospitals across the UK submitted 343 cases. Corticosteroids remain the mainstay of ITP treatment, but TPO‐RAs were more effective. Incidental COVID‐19 infection was identified in a significant number of patients (9·5%), while 14 cases were thought to be secondary to COVID‐19 vaccination. [ABSTRACT FROM AUTHOR]

The most severe form of SCD is homozygous SCD (HbSS) but SCD can also be due to compound heterozygous genotypes of HbS and another haemoglobin variant (e.g., HbC, HbD SP Punjab sp , HbE or thalassaemia, see Table I). Blood transfusion during pregnancy Transfusion has been used in pregnant women with SCD to correct severe anaemia and reduce sickle-related complications. Keywords: sickle cell anaemia; sickle cell disease; pregnancy; antenatal; intrapartum; preconceptual EN sickle cell anaemia sickle cell disease pregnancy antenatal intrapartum preconceptual 980 995 16 09/20/21 20210915 NES 210915 This guideline was compiled according to the British Society of Haematology (BSH) process at https://b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-guideline/. This has been discussed in a previous BSH guideline and a recent ASH guideline.43,44 There is currently insufficient evidence to recommend prophylactic transfusion over standard care (transfusion as required) and whilst there is some evidence that prophylactic transfusion will reduce vaso-occlusive pain during pregnancy it is not clear if the benefits of transfusion will outweigh the risks of transfusion (e.g., alloimmunisation). The type of blood selected for transfusion of women with SCD should be cytomegalovirus (CMV)-negative, HbS-negative and extended Rh- and Kell-matched in line with previous BSH recommendations.42 A full transfusion history should be taken from the patient at the booking appointment or first obstetric/haematology appointment and should include communication with the transfusion laboratory and national transfusion database to ensure there are no historical alloantibodies. [Extracted from the article]

Summary: The level of venous thrombosis risk in women who experience spontaneous or induced pregnancy loss has previously been uncertain. However, recent data indicate that the risk of venous thrombosis in women undergoing pregnancy termination in the first trimester is increased two‐fold compared to non‐pregnant women but reduced five‐fold compared to women in the 6 weeks following a term birth. The termination procedure itself appears not to influence thrombosis risk. In light of this data, this consensus statement provides recommendations for reducing the risk of venous thrombosis in women undergoing spontaneous or induced pregnancy loss based on Royal College of Obstetricians and Gynaecologists risk stratification guidelines. [ABSTRACT FROM AUTHOR]

In the UK, the prevalence of anaemia was found to be 24% in a multicentre national study (Barroso I et al i , [4]) and a two-centre English study found 46% of women had anaemia at the booking or 28-week checks (Nair I et al i , [55]). Data from the WHO, derived mainly from low-income countries, show that the risk of maternal mortality increases with the severity of anaemia, although the multiple causes of anaemia make it difficult to determine the direct effects of anaemia per se (Brabin I et al i , [9]) and at what Hb threshold mortality is increased. A recent systematic review showed there is marked variation in the threshold of serum ferritin used to diagnose iron deficiency, both in research studies and in national and international guidelines (Daru I et al i , [20]).The two benchmark studies that compared serum ferritin with iron stores in the bone marrow, and that have guided currently used thresholds, have significant limitations (Hallberg I et al i , [35]; van den Broek I et al i , [86]). Women with uncorrected anaemia antenatally should have a Hb check within 48 h of birth, as should those who have had blood loss >500 ml, or symptoms suggestive of postpartum anaemia. [Extracted from the article]