Harrington Patrick, Nelson-Piercy Catherine, Williamson Catherine, Cooper Nichola, Kesse-Adu Rachel, Robinson Susan
Guys and St Thomas' NHS Foundation Trust, Guys Hospital, London, UK.
King's College London, London, UK.
Obstet Med. 2018 Mar;11(1):35-38. doi: 10.1177/1753495X17709188. Epub 2017 Jul 10.
A 34-year-old woman presented at 29 weeks gestation of a twin pregnancy, with a platelet count of 1 × 10/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.
一名34岁女性在双胎妊娠29周时就诊，血小板计数为1×10⁹/L。她接受了全面检查，随后被诊断为严重免疫性血小板减少症。她对皮质类固醇和静脉注射免疫球蛋白的初始治疗无反应。她对二线治疗药物抗D免疫球蛋白、硫唑嘌呤和血小板生成素激动剂罗米司亭也无反应。她的病情因可能与硫唑嘌呤治疗有关的产科胆汁淤积症发作而进一步复杂化。在择期剖宫产时，她需要进行血浆置换，这使血小板计数得到了暂时改善，并实现了安全分娩。该病例凸显了妊娠期严重难治性免疫性血小板减少症患者管理中面临的一些挑战。
