Idiopathic thrombocytopenic purpura in pregnancy

Overview

Objective:
The study analyses a case of thrombocytopenic purpura in pregnancy.

Case report:
A decrease in the level of thrombocytes was detected and corticosteroid therapy was initiated in the 26th week of pregnancy of a 34-year-old primagravida with mild thrombocytopenia in preconception period. The patient was hospitalized on a repeated basis and her dosage of corticoids was increased when her level of platelets dropped to critical level. In the 34th week of gravidity, when the patient’s clinical picture was negative, her preparation for the labour started with the application of polyvalent human immunoglobulin. In view of potential thrombocytopaenia as a result of hepatomegaly of the foetus detected by ultrasonography and the resulting risk of bleeding complications, gravidity was terminated by caesarean resection, and splenectomy was performed. An immature foetus was born with Cushing‘s syndrome appearance, milia on face, and severe thrombocytopenia which was stabilised after immunoglobulin therapy. In the post-partum period, the patient’s blood count gradually returned to normal as a result of corticosteroid therapy. Asplenism as a chronic immunosuppressive condition was treated by vaccination in accordance with standard scheme, and by long-term antibiotic prophylaxis. The analysis shows that multidisciplinary approach involving an obstetrician, haematologist, neonatologist and a surgeon is important in the pre-partum and post-partum care for a patient with acquired idiopathic thrombocytopenic purpura, and that it is also important to determine the risk-benefi t ratio for corticosteroid therapy and immunotherapy in pregnancy.

Key words:
thrombocytopaenia – pregnancy – corticosteroid therapy – immunotherapy