A. Antsaklis et al., SUCCESSFUL MANAGEMENT OF SEVERE IDIOPATHIC THROMBOCYTOPENIA IN THE 2ND-TRIMESTER OF PREGNANCY, Fetal diagnosis and therapy, 13(4), 1998, pp. 233-235
This paper describes a case of severe idiopathic thrombocytopenia in a
primigravida. The disorder became symptomatic at 22 weeks gestation w
ith a platelet count of 20,000/mu l. The existence of chronic idiopath
ic thrombocytopenia under remission was strongly suspected, but could
not be documented. The patient was treated with oral corticosteroids o
ver a period of 7 weeks. During this period, she also had three cycles
of high-dose intravenous globulin. This treatment produced a transien
t improvement, but the platelet count fell to 4,000/mu l by the 29th g
estational week. Caesarean section was carried out for maternal indica
tion a week later, following a fourth intensified course of gamma-glob
ulin, coupled with platelet transfusions and low-dose vinblastine. Spl
enectomy was not performed. Potentially life-threatening thrombocytope
nia persisted for 6 weeks post partum. Despite the presence of circula
ting antiplatelet globulin in the maternal blood and the antenatal use
of vinblastine, the infant was entirely unaffected and thrived.