Background: A proportion of patients with idiopathic thrombocytopenic purpura (ITP) are refractory to treatment and in young women this poses risk to pregnancy and delivery.

Aims: –

Methods: –

Results: PLT dynamics during pregnancy
A 37-year-old woman presented with ITP since adolescence. She had already tried different therapeutic options, including glucocorticosteroids, splenectomy, cytostatics, thrombopoetin agonists and intravenous immunoglobulins (IVIG). All treatment had led to modest and transient effect and at that moment she received no therapy. Despite usual platelet counts (PLT) of around 10 G/l, the patient had no history of significant bleeding.For the last eight years, the woman had been struggling to conceive, including two unsuccessful in vitro ferilization (IVF) attempts. We planned another IVF procedure and 14 days before it, oral methylprednisolone (MP) was started. A single embryo was transfered at PLT 20 G/l and three weeks later pregnancy was confirmed. MP was continued throughout pregnancy, sustaining PLT slightly above 20 G/l, until gestational week 22 when the effect was lost and therapy was weaned.At week 37, the patient was hospitalized for planned caesarean section with PLT 2 G/l. High-dose dexamethasone was tried but PLT increased insignificantly. At that point, we applied a single infusion of IVIG 1g/kg and 48 hours later PLT were 101 G/l. The caesarean section was performed with normal intraopearitve blood loss. However, on day 4 after delivery, the woman had to be reoperated due to subfascial hematoma of the abdominal wall. This necessitated additional hematological support and after a week of recovery, the woman was discharged. Her newborn was clinically well but with severe neonatal thrombocytopenia, having PLT 6 G/l at birth.

Conclusions: Pregnancy should not be discouraged in women with refractory ITP. High-dose IVIG could rescue delivery and mitigate postpartum maternal bleeding but neonates are still at risk of severe thrombocytopenia.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/successful-infertility-treatment-and-pregnancy-outcome-in-a-woman-with-severe-treatment-refractory-itp/