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Management of refractory immune thrombocytopaenia in pregnancy
  1. Jessica M Heenan
  1. Haematology, Launceston General Hospital, Launceston, Tasmania, Australia
  1. Correspondence to Dr Jessica M Heenan; jessica.heenan{at}


A 25-year-old woman with a history of immune thrombocytopaenia (ITP) in childhood was referred to haematology clinic for review with a platelet count of 50 μ/L at 9 weeks gestation, gravida 2, para 0. She developed progressive severe thrombocytopaenia as the pregnancy progressed, with associated bleeding complications. The thrombocytopaenia was refractory to standard therapies. This led to a need for a planned delivery, which was performed via caesarean section under general anaesthetic with platelet transfusion support, Intravenous Immune Globulin (IVIG), high-dose corticosteroid and the thrombopoietin (TPO) mimetic romiplostim. Both the mother and the neonate survived; however, the neonate required treatment for severe prolonged neonatal thrombocytopaenia. The patient subsequently re-presented 15 months later with recurrent ITP complicating another pregnancy, refractory to rituximab but responsive to romiplostim. She had a successful elective caesarean section under epidural anaesthesia, but the neonate once again suffered severe thrombocytopaenia, which was responsive to IVIG.

  • haematology (drugs and medicines)
  • obstetrics
  • gynaecology and fertility
  • haematology (incl blood transfusion)
  • materno-foetal medicine
  • neonatal health

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  • Contributors JMH: sole author and contributed 100% to the concept, planning, design, data accrual, writing and submission of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.