Malutan Andrei Mihai, Pascu Oana Teodora, Diculescu Doru, Ciortea Razvan, Blaga Ligia, Nicula Renata, Bucuri Carmen, Roman Maria, Nati Ionel, Ormindean Cristina Mihaela, Suciu Viorela, Mihu Dan
2nd Department of Obstetrics and Gynecology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Department of Neonatology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
J Clin Med. 2025 Jan 28;14(3):872. doi: 10.3390/jcm14030872.
Thrombocytopenia, defined as a platelet count below 150 × 10/L, is the second most common hematological abnormality after anemia found among European women in the third trimester of pregnancy. Most of the cases are mild, asymptomatic, and diagnosed accidentally. The primary causes of thrombocytopenia are linked to the pregnancy itself and include gestational thrombocytopenia (GT), autoimmune thrombocytopenia (ITP), and pre-eclampsia or HELLP syndrome-associated thrombocytopenia. First-line therapies for ITP include corticosteroids and intravenous immunoglobulin (IVIG). We came across a case of severe thrombocytopenia (platelet count of 9 × 10/L) associated with severe anemia (Hb 5.9 g/dL) at 30 weeks of gestation, with no personal or family history of bleeding disorders. A comprehensive hematologic, infectious, and rheumatological workup was performed to narrow the diagnosis. Despite aggressive corticosteroid therapy and immunoglobulin treatment, the patient's thrombocytopenia persisted, imposing delivery at 34 weeks. This article highlights the complex presentation and management of severe thrombocytopenia and anemia during pregnancy.
血小板减少症定义为血小板计数低于150×10⁹/L，是欧洲妊娠晚期女性中仅次于贫血的第二常见血液学异常。大多数病例为轻度、无症状，是偶然诊断出来的。血小板减少症的主要病因与妊娠本身有关，包括妊娠期血小板减少症（GT）、自身免疫性血小板减少症（ITP）以及子痫前期或HELLP综合征相关的血小板减少症。ITP的一线治疗方法包括使用皮质类固醇和静脉注射免疫球蛋白（IVIG）。我们遇到了一例妊娠30周时出现严重血小板减少症（血小板计数为9×10⁹/L）并伴有严重贫血（血红蛋白5.9g/dL）的病例，患者无个人或家族出血性疾病史。进行了全面的血液学、感染性和风湿性检查以明确诊断。尽管进行了积极的皮质类固醇治疗和免疫球蛋白治疗，但患者的血小板减少症仍持续存在，因此在34周时进行了分娩。本文强调了妊娠期严重血小板减少症和贫血的复杂表现及管理。
