Clinical case of severe immune thrombocytopenia during pregnancy

Abstract

Immune thrombocytopenia (ITP) is one of the most common causes of thrombocytopenia (TP) in pregnancy and is the main cause of severe TP among pregnant women. Autoimmune pathogenesis determines the danger of hemorrhagic complications both for the pregnant and for the fetus and newborn. Differential diagnosis between gestational and immune thrombocytopenia is necessary, as this determines further tactics. The goal of ITP treatment is to achieve a safe level of platelets according to the gestational age and clinical situation. For treatment, different lines of therapy are used alternately with step-by-step control of effectiveness. Purpose - to analyze the worldwide and personal experience of pregnancy management in severe ITP refractory to treatment. We present a case of pregnancy management and delivery with a severe immune thrombocytopenia, diagnosed at 25 weeks of pregnancy with hemorrhagic syndrome, unresponsive to treatment. All pharmacological tools were used. Delivery by caesarean section with appropriate preoperative and intraoperative transfusion preparation. Recombinant human thrombopoietin was used in the postoperative period. The newborn has thrombocytopenia without hemorrhagic syndrome. Conclusions. Correct diagnosis of conditions accompanied by thrombocytopenia during pregnancy determines the correct and effective treatment tactics. Pregnancy and childbirth in women with severe thrombocytopenia belong to the group of extremely high risk. Antenatal management and delivery of such pregnant women should be carried out by a multidisciplinary team with the participation of a hematologist, a specialist in internal medicine, under careful control of laboratory indicators and clinical changes, with control of the fetal antenatal condition. It is necessary to control the platelet level of the newborn in the postnatal period. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.