Immune Thrombocytopenia Purpura during Pregnancy: A Case Report

Immune thrombocytopenia purpura (ITP) is an autoimmune disorder characterized by autoantibody binding to platelet antigens causing premature platelet destruction by the reticuloendothelial system, particularly the spleen. The prevalence thrombocytopenia in pregnancy between 7 % and 12 % of all pregnant women. There are many causes of thrombocytopenia in pregnancy. A 21 years old female primigravida at 41 weeks came to the emergency obstetrics and gynecology department with a vaginal discharge of clear fluid, with no uterine contractions or bleeding since 4 hours prior and active fetal movement. Regarding her history since childhood, she had epistaxis and bruises. From physical examination was within normal limit. The obstetric examination revealed her fundal height was 2 fingers below xiphoid process, fetal heart rate was 148 x/minutes, the spleen and liver had normal size. The vaginal toucher examination showed one finger of cervical opening, 25 percent dilatation of cervical, and slightly blood slime. Lakmus test was positive. Her hematological examination revealed that leucocyte 9.330/μL, erythrocyte 4.460/μL, hematocrit 40.1 %, platelet count 18.000/μL, Hemoglobin 13.4 g/dl, bleeding time 2 min and clotting time 12 min of blood. Peripheral blood smear test revealed platelet count is decreased with some giant platelets, the morphology of erythrocyte and leucocyte was normal. The patient was diagnosed with immune thrombocytopenia purpura and premature rupture of the membrane in pregnancy. During hospitalization, She was transfused with platelet concentrates and treated with amoxicillin and methylprednisolone. Immune trombocytopenia purpura (ITP) is the problem hematological abnormality occurring during pregnancy. Corticosteroid is the most commonly used first-line therapy to stop further destruction of platelets. ITP in pregnancy requires monitoring and may need treatment to improve platelet counts for delivery.