Background Thrombocytopenia is a frequent finding in pregnancy. Thrombocytopenia may be gestational thrombocytopaenia, associated with systemic disease, or may indicate immune thrombocytopenia (ITP). The latter complicates 1-2 in 1,000 pregnancies and whilst it accounts for only 5% of cases of thrombocytopaenia in pregnancy, it can be associated with maternal and neonatal morbidity.
Case report A 34 year old G 3 P, Mrs J, presented at 8/40 gestation with a petechial rash. A full blood count showed thrombocytopenia (platelet count 10x109/L), with a normal blood film. A diagnosis of ITP was made and she was commenced on Prednisolone 80mg daily. Within 48 hours of admission she developed a left sided headache; a CT scan revealed a left sided extradural haematoma. She received a platelet transfusion and a 2 day course of IV Immunoglobins. Mrs J responded well and her headache resolved. Steroids were reduced to 5-20mg to maintain a count above>100 x109/L. She presented in labour at 36 weeks gestation, deliveringa male infant weighing 2.94Kg, with a normal cord platelet count. Blood loss at delivery was 350mls. Mrs J remains well with platelets of 110-150 x109/L on low dose prednisolone.
Discussion Management of ITP in pregnancy depends on platelet count and haemorrhagic tendency, aiming to optimise platelet count for delivery. It is not uncommon to manage women with platelet counts < 20 x 109/l conservatively until late second trimester, having established steroid responsiveness. Maternal thrombocytopenia can be associated with neonatal thrombocytopenia although absolute levels do not correlate.
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