Maternal and Neonatal Idiopathic Thrombocytopenic Purpura| Stephy Publishers

 

SOJ Pediatrics and Clinical Neonatology - (SOJPCN)| Stephy Publishers

Introduction

Immune thrombocytopenic (ITP) is an autoimmune disease that affects 9.5/100,000 adults in the population.¹ It is characterized by autoimmune destruction of platelets leading to potentially life-threatening thrombocytopenia. About 7% of pregnant mothers are affected by thrombocytopenia with 1 to 10 per 10,000 mothers being affected with ITP. Studies have shown that ITP is generally a benign condition in the birthing mother and rarely has a long-lasting effect on the newborn child.² In the rare event that the newborn is severely affected, treatment is required. We present a case of ITP in both a mother and her newborn.

Case Report

The infant is a 40 weeks and 1 days gestational female who was born via spontaneous vaginal delivery to a 35 year old now gravida 3, para 3 Hispanic mother with a history of ITP of pregnancy. Mother was group B streptococcus positive but otherwise negative for all other serologies. Per maternal report and prior medical records, her first pregnancy revealed platelets that had declined to 19,000/ mm3 that recovered to 85,000/mm³ after intravenous methylprednisolone. That delivery was complicated with post-partum bleeding requiring a transfusion of two units of packed red blood cells. Records were unavailable for her first infant, but it reportedly did well and treatment was not necessary. Mother was discharged with steroids and hematology follow-up but did not continue evaluation and monitoring secondary to financial difficulty. No data was available for her second infant as she did not deliver at our institution. Per maternal report, that infant also suffered from ITP but severity was unknown.

The mother returned to our institution to establish care for our patient at 34 weeks gestation. Her prenatal course was complicated only with gestational diabetes that was diet controlled. She was admitted to the hospital at 39 weeks 4 days gestation for induction due to gestational diabetes mellitus and a presumed large for gestational age fetus. Her platelets upon admission were 36,000/mm³ with no signs of bleeding or bruising. The hematology service was consulted prior to induction and recommended high dose prednisone (80mg) initially. Maternal platelets did not recover after this single steroid therapy, thus intravenous immunoglobulin (IVIg) 1g/ kg was started along with an additional dose of prednisone 80mg. Again, maternal platelets did not respond but remained stable at 43,000/mm³. After discussion with the hematology service, the obstetrics team administered an additional dose of IVIg and proceeded with induction with the plan to give one unit of platelets during active labor. The infant’s delivery was vaginal and uncomplicated. Her initial APGAR scores were ¹ at one minute and 6 at 5 minutes and she was transferred to the neonatal intensive care unit (NICU) for continuous positive airway pressure for treatment of apnea. Her apnea quickly resolved and she was observed in the NICU for several hours and then transferred to the newborn nursery service. Following transfer, a complete blood count (CBC) was drawn that revealed a platelet count of 108,000/mm³. She had no signs and symptoms of bleeding or bruising and thus was observed. A repeat CBC was drawn on postnatal day two which resulted in a declining platelet count of 69,000/mm³. The pediatric hematology service was consulted and recommendations included prednisone 2 mg/kg twice daily for 5 days. Her platelets continued to decrease to 25,000/mm³ by her third day of life. She was subsequently transferred to the NICU for IVIg therapy 1g/kg every 12 hours. The infant tolerated IVIg therapy well with an improvement in her platelets to 64,000/mm³. She was discharged in good condition at 5 days of life.

To read more #Pediatrics #ClinicalNeonatology
https://www.stephypublishers.com/sojpcn/fulltext/SOJPCN.MS.ID.000504.php

#Openaccessjournals
https://www.stephypublishers.com/