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.
Antsaklis
A
A
Division of Maternal Fetal Medicine, First Department of Obstetrics and Gynecology, Alexandra Hospital, School of Medicine, University of Athens, Greece.
Papageorgiu
I
I
Sindos
M
M
Katsimanis
E
E
Karaiskakis
P
P
Michalas
S
S
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