A rare and successfully managed case of idiopathic thrombocytopenic purpura (ITP) with previous caesarean with splenectomy with hepatitis C positive


  • Rajshree Dayanand Katke Department of Obstetrics & Gynaecology, Cama and Albless Hospitals, Sir J.J. Group of Hospitals, Mumbai-400001, Maharashtra, India


Idiopathic thrombocytopenic purpura, ITP with pregnancy


ITP occurs in approximately 2 of 1000 pregnant women. ITP may develop at any time during pregnancy, but is often initially recognized in the first trimester and is the most common cause of isolated thrombocytopenia in this time period. A 33 year old, married since 6 years, G2p1l1 with 33 weeks gestation referred to our tertiary centre. She was a known case of ITP with splenectomy done. She had a 5 year old male child, delivered by LSCS. She was diagnosed as having ITP at the age of 12 years. HCV antibody was weakly positive. ANA was positive. Emergency LSCS was done in view of scar tenderness. Post op she developed epistaxis, bleeding gums and per vaginum. Patient received multiple FFP, platelet transfusions and responded to treatment with methylprednisolone. The diagnosis and management of ITP in pregnancy is similar to that in the non-pregnant adult patient, but the risks to the developing fetus must be taken into account when choosing treatment and the maintenance of a safe platelet count, rather than prolonged remission, is the goal. Mode of delivery must be guided by obstetrical indications.


Jamaes N. George, Muzahid A. Rizvi. Thrombocytopenia. In: Ernest Beutler, Marshall A. Lichtman, Barry S. Coller, Thonmas J Kipps, Uri Seligsohn, eds. Williams Haematology. 6th ed. New York: McGraw-Hill; 2001: 1514-1520.

Giles C, Inglis TCM. Thrombocytopenia and macrothrombocytosis in gestational hypertension. Br J Obstet Gynaecol. 1981;88:1115.

Carr JM, Kruskall MS, Kaye JA, Robinson SH. Efficacy of platelet transfusions in immune thrombocytopenia. Am J Med. 1986;80:1051.

Frank Firkin, Colin Chesterman, David Penington, Bryan Rush. The hemorrhagic disorder: capillary and platelet defects. In: Frank Firkin, Colin Chesterman, David Penington, Bryan Rush, eds. de Gruchy’s Clinical Haematology in Medical Practice. 5th ed. UK: Blackwell Science; 1989: 377-385.

Robert N. Handin. Clotting disorders. In: Robert N. Handin, eds. Harrison Principle of Medicine. 13th ed. New York: McGraw-Hill; 1994: 1800.

George JN, EI-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. N Eng J Med. 1994;331:1207.

Lynnae Millar. Immune thrombocytopenia and pregnancy, 2014. Available at: http://emedicine.medscape.com/article/208697-clinical. Accessed 5 June 2014.

Keith Edmonds. Disorders of platelets in pregnancy. In: Keith Edmonds, eds. Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates. 6th ed. UK: Blackwell Science; 1999: 229-233.

Gill KK, Kelton JG. Management of idiopathic thrombocytopenic purpura in pregnancy. Semin Haematol. 2000;37(3):275-89.

Won YW, Moon W, Yun YS, Oh HS, Choi JH, Lee YY, et al. Clinical aspects of pregnancy and delivery in patients with chronic idiopathic thrombocytopenic purpura (ITP). Korean J Intern Med. 2005;20(2):129-34.

Fujimura K, Harada Y, Fujimoto T, Kuramoto A, Ikeda Y, Akatsuka J, et al. Nationwide study of idiopathic thrombocytopenic purpura in pregnant women and the clinical influence on neonates. Int J Haematol. 2002;75(4):426-33.

Karpatkin S. Autoimmune thrombocytopenic purpura. Semin Haematol. 1985;22(4):260-88.

Besa EC, MacNab MW, Solan AJ, Lapes MJ, Marfatia U. High-dose intravenous IgG in the management of pregnancy in women with idiopathic thrombocytopenic purpura. Am J Haematol. 1985;18(4):373-9.

Kaplan C, Daffos F, Forestier F, Tertian G, Catherine N, Pons JC, et al. Fetal platelet counts in thrombocytopenic pregnancy. Lancet. 1990;336(8727):979-82.

Bussel JB, Druzin ML, Cines DB, Samuels P. Thrombocytopenia in pregnancy. Lancet. 1991;337(8735):251.