[Immune thrombocytopenia, anemia and leukopenia during pregnancy. Successful therapy with extracorporeal immunoadsorption].
METHODS
A 28-year-old woman in her fourth pregnancy had a positive direct Race-Coombs test in her 14th week of pregnancy. About 6 weeks later she developed marked anaemia, severe thrombocytopenia and leukopenia with nose-bleeds as well as petechiae over the lower abdomen and the inguinal regions.


METHODS
Platelet count was 7000/microliter, haemoglobin concentration 4.8 mmol/l (7.73 g/dl) and WBC count 2600/microliter). Bleeding time was markedly prolonged. Erythrocyte-attached immunoglobulin G and complement components as well as antithrombocyte and antigranulocyte antibodies were demonstrated. Haemoblastosis or aplastic anaemia was excluded by bone marrow examination.


METHODS
The pancytopenia with immune thrombocytopenia, autohaemolytic anaemia and associated leukopenia were classified as Evans syndrome. Administration of glucocorticoids and of immunoglobulins intravenously for 5 days failed to improve the blood picture significantly. But platelet count rose significantly on immunoadsorption (Ig Therasorb columns), allowing the pregnancy to proceed.


CONCLUSIONS
In life-threatening states Ig immunoadsorption can achieve well tolerated, effective and specific elimination of pathogenetically relevant antibodies against blood cells and can also be applied in pregnant women.
Julius
U
U
Institut und Poliklinik für Klinische Stoffwechselforschung, Medizinischen Fakultät Carl Gustav Carus der Technischen Universität Dresden.
Patzak
A
A
Schaich
M
M
Ehninger
G
G
Kamin
G
G
D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000628:therapy*; D003176:Complement C3 / Q000032:analysis; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007163:Immunosorbent Techniques; D007970:Leukopenia / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D006435:Renal Dialysis; D013921:Thrombocytopenia / Q000150:complications / Q000628:therapy*
D001323:Autoantibodies; D003176:Complement C3; D007074:Immunoglobulin G
Immunogene Thrombozytopenie, Anämie und Leukopenie während Schwangerschaft. Erfolgreiche Extrakorporaltherapie mit immunadsorption.