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- Title
Refractory severe immune thrombocytopenia in a twin pregnancy.
- Authors
Harrington, Patrick; Nelson-Piercy, Catherine; Williamson, Catherine; Cooper, Nichola; Kesse-Adu, Rachel; Robinson, Susan
- Abstract
A 34-year-old woman presented at 29 weeks gestation of a twin pregnancy, with a platelet count of 1 × 109/l. She was extensively investigated and was subsequently diagnosed with severe immune thrombocytopenia. She did not respond to initial treatment with corticosteroids and intravenous immunoglobulin. She also failed to respond to second-line therapies of Anti-D immunoglobulin, Azathioprine and the thrombopoietin agonist Romiplostim. Her case was further complicated by an episode of obstetric cholestasis possibly related to Azathioprine treatment. She went on to require plasma exchange around the time of an elective Caesarean section which provided temporary improvement in the platelet count and enabled safe delivery. This case highlights some of the challenges faced in the management of patients with severe and refractory immune thrombocytopenia during pregnancy.
- Subjects
ADRENOCORTICAL hormones; HORMONE therapy; COLONY-stimulating factors (Physiology); THERAPEUTIC use of immunoglobulins; THROMBOPENIC purpura diagnosis; BLOOD plasma; CESAREAN section; CHOLESTASIS; DELIVERY (Obstetrics); GESTATIONAL age; THROMBOPENIC purpura; SEVERITY of illness index; AZATHIOPRINE; PLATELET count; DISEASE complications; PREGNANCY; THERAPEUTICS
- Publication
Obstetric Medicine (1753-495X), 2018, Vol 11, Issue 1, p35
- ISSN
1753-495X
- Publication type
Article
- DOI
10.1177/1753495X17709188