Severe Case of Autoimmune Thrombocytopenia First Diagnosed in Pregnancy

Abstract

We report on a 28-year old primigravida who presented in the second trimester with sudden onset of bleeding tendencies and thrombocytopenia of 2/nL during the first manifestation of autoimmune thrombocytopenia (ITP). Therapy with intravenous immunoglobulins (IVIG) and steroids was initiated but could not prevent renewed bleeding incidents and recurrent thrombocytopenia in the long term, thus premature delivery by Caesarean section in the 32 + 3 week of pregnancy could not be avoided. The bleeding complications could only be mastered by multiple thrombocyte transfusions. Because the ITP remained refractory to therapy in the postpartum period a thrombopoietin receptor agonist (TPO-RA) was administered. This led to an increase in the thrombocyte count which was later stabilised by prednisolone alone.

Zusammenfassung

Wir berichten von einer 28-jährigen Erstgravida, die sich im 2. Trimenon mit plötzlich aufgetretener Blutungsneigung und Thrombozytopenie von 2/nl bei der Erstmanifestation einer ITP vorstellte. Die initiierte Therapie mit intravenösen Immunglobulinen (IVIG) und Steroiden konnte erneute Blutungsereignisse und rezidivierende Thrombozytopenien langfristig nicht verhindern, sodass eine vorzeitige Entbindung per Sectio nach Applikation der Lungenreifeinduktion in 32 + 3 SSW nicht vermeidbar war. Die Blutungskomplikationen konnten nur durch multiple Thrombozytentransfusionen beherrscht werden. Aufgrund postpartaler Therapierefraktärität der ITP wurde ein Thrombopoetin-Rezeptoragonist (TPO-RA) appliziert, der zum Anstieg der Thrombozytenzahl führte, die später mithilfe von Prednisolon allein stabilisiert werden konnte.

Key words

pregnancy - ITP - autoimmune thrombocytopenia - obstetrics - premature birth - coagulopathy

Schlüsselwörter

Schwangerschaft - ITP - Autoimmunthrombozytopenie - Geburtshilfe - Frühgeburt - Koagulopathie

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