Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Severe Immune Thrombocytopenic Purpura in a Patient at 33 Weeks of Gestation: A Case Report

Authors
Rawad Halimeh 1
Joseph Klim 2
Lea Aoude 2
Marianne Bersaoui 3
Bernard Najib 4
Saab Wiam 5
Fadi Fakhoury 6
Rana Skaf 3
1 The Centre for Reproductive and Genetic Health (CRGH), London, UK
2 Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
3 Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
4 Centre Antoine Lacassagne, Nice, France
5 Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
6 Department of Anesthesia, Montreuil Intercommunal Hospital Center, Montreuil, France
10.18502/jri.v26i1.18782
Abstract
Background: Immune thrombocytopenia (ITP) is an autoimmune condition that affects individuals of all ages, leading to a heightened risk of bleeding. ITP accounts for 5% of all pregnancy-related thrombocytopenia cases with an incidence of 1 in every 1,000 pregnant women. Several conditions can cause thrombocytopenia during pregnancy, making the diagnosis challenging. Current treatment of patients with ITP focuses on maintaining a safe platelet count rather than correcting it to normal levels. Case Presentation: This article presents a case of a 26-year-old patient at 33 weeks of gestation with severe symptoms of thrombocytopenia, evidenced by a platelet count of 1000/mm 3 . The patient experienced self-resolving episodes of gingival bleeding, vaginal bleeding, and petechiae on her abdomen, as well as on both upper and lower extremities, over a duration of three days. She was successfully managed with prednisolone and intravenous immunoglobulin (IVIG), resulting in favorable maternal and neonatal outcomes. Conclusion: While there are currently no universally accepted guidelines for the treatment of ITP, expert consensus recommendations are available. Therefore, treatment should be individualized and closely monitored. A multidisciplinary team approach is essential for the effective management of ITP during pregnancy.
Keywords
Bleeding
Immune thrombocytopenia
immunoglobulins
Platelet count
Prednisolone
Pregnancy
Purpura
Cooper N, Bussel J. The pathogenesis of immune thrombocytopaenic purpura. Br J Haematol. 2006; 133(4):364-74.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-93.
Amorim JG de, Abecasis MR, Rodrigues FMNL. Refractory severe thrombocytopenia during pregnancy: how to manage. Rev Bras Ginecol Obstet. 2018;40(12):803-7.
Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2009; 23(6):1299-316.
Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood. 2003;102(13):4306-11.
British committee for standards in haematology general haematology task force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(4):574-96.
Godeau B, Provan D, Bussel J. Immune thrombocytopenic purpura in adults. Curr Opin Hematol. 2007; 14(5):535-56.
Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood. 1991;77(1):31-3.
Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160(11):1630-8.
George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American society of hematology. Blood. 1996;88(1):3-40.
Ferreira IJMCF, Sousa F, Vasco EM, Areia ALF de A, Moura JPAS, Carda J, et al. Severe immune thrombocytopenia in pregnancy treated with Eltrombopaga case report. J Gynecol Obstet Hum Reprod. 2018;47(8):405-8.
Sieunarine K, Shapiro S, Al Obaidi MJ, Girling J. Intravenous anti-D immunoglobulin in the treatment of resistant immune thrombocytopenic purpura in pregnancy. BJOG. 2007;114(4):505-7.
Veneri D, Franchini M, Raffaelli R, Musola M, Memmo A, Franchi M, et al. Idiopathic thrombocytopenic purpura in pregnancy: analysis of 43 consecutive cases followed at a single Italian institution. Ann Hematol. 2006;85(8):552-4.
Gilmore KS, McLintock C. Maternal and fetal outcomes of primary immune thrombocytopenia during pregnancy: a retrospective study. Obstet Med. 2018;11(1):12-6.
Wegnelius G, Bremme K, Lindqvist PG, on the behalf of Hem-ARG, a reference, working group of obstetricians regarding hematological issues in Obstetrics, gynecology under the auspices of the Swedish society of obstetrics, gynecology. Efficacy of treatment immune thrombocytopenic purpura in pregnancy with corticosteroids and intravenous immunoglobulin: a prospective follow-up of suggested practice. Blood Coagul Fibrinolysis. 2018; 29(2):141-7.
Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013;121 (1):38-47.
Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytepenia. Blood. 2010;115(2):168-86.
Bussel J. Intravenous immune serum globulin in immune thrombocytopenia: clinical results and biochemical evaluation. Vox Sang. 1985;49 Suppl 1:44-50.
Spahr JE, Rodgers GM. Treatment of immune-mediated thrombocytopenia purpura with con-current intravenous immunoglobulin and platelet transfusion: a retrospective review of 40 patients. Am J Hematol. 2008;83(2):122-5.
Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Crowther MA, et al. The American society of hematology 2011 evidence-based practice guide-line for immune thrombocytopenia. Blood. 2011; 117(16):4190-207.
21. Bussel JB, Zabusky MR, Berkowitz RL, Mc-Farland JG. Fetal alloimmune thrombocytopenia. New Engl J Med. 1997;337(1):22-6.
22. Mithoowani S, Gregory-Miller K, Goy J, Miller MC, Wang G, Noroozi N, et al. High-dose dexa-methasone compared with prednisone for previ-ously untreated primary immune thrombocytope-nia: a systematic review and meta-analysis. Lancet Haematol. 2016;3(10):e489-96.
Pietras NM, Gupta N, Justiz Vaillant AA, Pearson-Shaver AL. Immune thrombocytopenia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Khaspekova SG, Shustova ON, Golubeva NV, Naimushin YA, Larina LE, Mazurov AV. Circulating antiplatelet antibodies in pregnant women with immune thrombocytopenic purpura as predictors of thrombocytopenia in the newborns. Platelets. 2019;30(8):1008-12.
Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated inter-national consensus report on the investigation and management of primary immune thrombocyto-penia. Blood Adv. 2019;3(22):3780-817.
Almizraq RJ, Branch DR. Efficacy and mechanism of intravenous immunoglobulin treatment for im-mune thrombocytopenia in adults. Ann Blood. 2021;6:2-2.
Journal of Reproduction & Infertility
Volume 26, Issue 1
Winter 2025
Pages 58-63