SUCCESSFUL MANAGEMENT OF SEVERE IDIOPATHIC THROMBOCYTOPENIA IN THE 2ND-TRIMESTER OF PREGNANCY

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.