Objective Immune thrombocytopenic purpura (ITP) is a rare but important cause of thrombocytopenia in pregnancy, accounting for approximately 5% of cases of pregnancy-associated thrombocytopenia and affecting 1-2 in 1000 pregnancies.1 Its diagnosis is often complicated due to a wider differential diagnosis which includes gestational thrombocytopenia, TTP/HUS syndrome, pre-eclampsia and HELLP syndrome. We herein describe two cases of new-onset ITP in pregnancy.
Case reports Patient A, a Para 0+3 27 year African lady with known sickle-cell trait and no prior history of ITP, booked with platelets of 88,000/μl and her platelet count was monitored throughout the pregnancy. She was induced at 38+1 due to intra-uterine growth restriction (IUGR) at which point her platelet count had fallen to 49,000/μl. She delivered vaginally and did not require steroids or a platelet transfusion. Cord blood from the baby did not reveal a thrombocytopenia.
Patient B, a Para 1 31 year old Sri-Lankan lady, booked with a platelet count of 257,000/μl. She was admitted at 28 weeks of gestation with petechiae and bleeding gums and platelet count was found to be 2,000/μl. A bone marrow trephine and biopsy were indicative of ITP and she received a platelet transfusion. She has been commenced on Prednisolone 60mg. She is currently 36 weeks gestation and is under regular surveillance.
Discussion Both cases illustrate the complexity of ITP. Early diagnosis is necessary in order to optimise anaesthetic options for delivery and reduce the risk of post-partum haemorrhage. Management of ITP in pregnancy is therefore challenging, requiring a multidisciplinary collaboration.
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