Successful management of severe idiopathic thrombocytopenia in the second trimester of pregnancy.
This paper describes a case of severe idiopathic thrombocytopenia in a primigravida. The disorder became symptomatic at 22 weeks gestation with a platelet count of 20,000/microliter. The existence of chronic idiopathic thrombocytopenia under remission was strongly suspected, but could not be documented. The patient was treated with oral corticosteroids over a period of 7 weeks. During this period, she also had three cycles of high-dose intravenous globulin. This treatment produced a transient improvement, but the platelet count fell to 4,000/ microl by the 29th gestational week. Caesarean section was carried out for maternal indication a week later, following a fourth intensified course of gamma-globulin, coupled with platelet transfusions and low-dose vinblastine. Splenectomy was not performed. Potentially life-threatening thrombocytopenia persisted for 6 weeks post partum. Despite the presence of circulating antiplatelet globulin in the maternal blood and the antenatal use of vinblastine, the infant was entirely unaffected and thrived.
Division of Maternal Fetal Medicine, First Department of Obstetrics and Gynecology, Alexandra Hospital, School of Medicine, University of Athens, Greece.
A
A
Antsaklis
I
I
Papageorgiu
M
M
Sindos
E
E
Katsimanis
P
P
Karaiskakis
S
S
Michalas
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D010976:Platelet Count; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011262:Pregnancy Trimester, Second; D013921:Thrombocytopenia / Q000628:therapy*; D014747:Vinblastine / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D014747:Vinblastine