Splenectomy during cesarean section in a patient with severe idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment

Abstract

Idiopathic thrombocytopenic purpura (ITP) is a disease of women of reproductive age and accounts for 5% of pregnancy associated thrombocytopenia. We reported the case of 21-year-old primigravida with ITP who was admitted to our hospital at the 28th weeks of gestation with platelet count of 22x109/l. Despite medicament treatment (prednisone, intravenous immunoglobulin /IgG/) there were falls in the platelet count, last at the 33rd week of gestation when platelet count was 15x109/l. In consultation with hematologist and surgeon we decided to deliver the patient by cesarean sec- tion during which splenectomy will be done. Patient received 60g of intravenous IgG two days before operations which were performed at the 34th week of gestation. Healthy female infant was born with normal platelet count and maternal platelet count at the discharge from hospital was 346x109/l.