Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy.
BACKGROUND
Immune thrombocytopenic purpura (ITP) is a condition with potential hazard during pregnancy for both mother and fetus if platelet concentrations fall below a critical level. This report describes the use of laparoscopic splenectomy following unsuccessful medical management.


METHODS
A 35-year-old primigravid woman with systemic lupus erythematosis (SLE) developed ITP several years before becoming pregnant. She was treated early in pregnancy with high-dose oral prednisone and weekly intravenous immunoglobulin (IVIG) alternating with anti-D immune globulin, but laparoscopic splenectomy was indicated at 20 weeks' gestation because of thrombocytopenia. Following surgery, she continued prednisone and intermittent IVIG therapy until spontaneous delivery at 34 weeks' gestation. A small accessory spleen was identified postpartum by nuclear medicine scan. Satisfactory platelet concentrations were maintained postpartum using danazol and prednisone.


CONCLUSIONS
Laparoscopic splenectomy is a therapeutic option for women with ITP during pregnancy that fails to respond to medical management.
Griffiths
Jill
J
Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB.
Sia
Winnie
W
Shapiro
A M James
AM
Tataryn
Ivanna
I
Turner
A Robert
AR
D000328:Adult; D003613:Danazol / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010535:Laparoscopy; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D010976:Platelet Count; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy / Q000601:surgery*; D011256:Pregnancy Outcome; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013921:Thrombocytopenia / Q000188:drug therapy / Q000601:surgery
D016756:Immunoglobulins, Intravenous; D003613:Danazol; D011241:Prednisone