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

Rawad  Halimeh; Joseph  Klim; Lea  Aoude; Marianne  Bersaoui; Bernard  Najib; Wiam  Saab; Fadi  Fakhoury; Rana  Skaf

doi:10.18502/jri.v26i1.18782

Rawad Halimeh Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
Joseph Klim Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
Lea Aoude Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
Marianne Bersaoui Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
Bernard Najib Centre Antoine Lacassagne, Nice, France
Wiam Saab Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
Fadi Fakhoury Department of Anesthesia, Montreuil Intercommunal Hospital Center, Montreuil, France
Rana Skaf Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon

DOI: https://doi.org/10.18502/jri.v26i1.18782

Keywords: Bleeding, Immune thrombocytopenia, Immunoglobulins, Platelet count, Prednisolone, Preg-nancy, Purpura

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/mm³. 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.