title: Successful prevention of exacerbation of thrombocytopenia in a pregnant patient with idiopathic thrombocytopenic purpura by anticoagulation treatment.
abstract: BACKGROUND
  Corticosteroid or intravenous immunoglobulin is used in the management of idiopathic thrombocytopenic purpura during pregnancy.
  
  
  METHODS
  A patient with idiopathic thrombocytopenic purpura had a previous history of interrupted pregnancy due to severe thrombocytopenia, and was unresponsive to high doses of corticosteroids and intravenous immunoglobulin. Immediately following pregnancy, our patient had a marked elevation in plasma levels of fibrinogen degradation products, D-dimer, and platelet factor 4, with a decrease in platelets, suggesting platelet activation and thrombogenesis. Combined treatment with an anticoagulant agent could prevent exacerbation of thrombocytopenia throughout pregnancy. Although the underlying causes leading to the series in her pregnancy course were uncertain, there were notable serological abnormalities, such as weakly positive antinuclear antibody and anti-U1-RNP antibody.
  
  
  CONCLUSIONS
  When thrombocytopenia rapidly develops in patients with idiopathic thrombocytopenic purpura immediately following pregnancy, the possibility of a thrombogenic state and differential diagnosis, including antiphospholipid syndrome and collagen vascular disease, should be considered. Treatment with an anticoagulant agent might then be appropriate.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535, Tokyo, Japan. hisano-m@ncchd.go.jp.
authors.forename: Michi
authors.initials: M
authors.lastname: Hisano
authors.affiliation: Division of Hematology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, 150-8935, Tokyo, Japan. tsukada_nobuhiro@med.jrc.or.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsukada
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535, Tokyo, Japan. sagou-h@ncchd.go.jp.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535, Tokyo, Japan. yamaguchi-k@ncchd.go.jp.
authors.forename: Koushi
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005938:Glucocorticoids / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D015539:Platelet Activation / Q000187:drug effects; D010976:Platelet Count / Q000379:methods; D011239:Prednisolone / Q000627:therapeutic use; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D011256:Pregnancy Outcome; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D017584:Reproductive History; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D006493:Heparin; D011239:Prednisolone