Recurrent thrombocytopenia in pregnancy: is it always an obstetric complication?
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IM - CASE RECORD
Recurrent thrombocytopenia in pregnancy: is it always an obstetric complication? Angelo Ostuni1 · Giovanni Favuzzi2 · Cosima Battista1 · Angela Tullo1 · Filomena Cappucci2 · Alexander Makatsariya3 · Giovanni Luca Tiscia2 · Elvira Grandone2,3 Received: 4 March 2019 / Accepted: 21 June 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Grandone (obstetrics and gynecology), Battista (hematology) Clinical case presentation We describe the case of a Caucasian woman from Southern Italy, who delivered for the first time in September 2000 at 21 years; 4 months later she showed fever and disturbed consciousness; a blood count prescribed on this occasion demonstrated a dramatic platelet drop, that was successfully treated by means of corticosteroids and Plasma-Exchange (PEX). In April 2004 at 34th week of her second pregnancy, she was admitted to the hospital because of a severe thrombocytopenia and normocytic anemia; a cesarean section (CS) was planned, but she delivered by a vaginal birth a male weighing 2700 g. She was transfused with red blood cells (RBC) and successfully treated by corticosteroids and plasma. At the age of 33 years, she came to our attention (January 2014) during the 26th week of her third pregnancy because of powerful headache and severe epistaxis. Her blood pressure was 180/90. Laboratory findings showed a severe thrombocytopenia and normocytic anemia (Table 1). The results of coagulation tests showed elevated D-dimer (7178 µg/L, nv: 0–500) and 24-h urine test revealed * Elvira Grandone [email protected] Angelo Ostuni [email protected] 1
UOC Medicina Trasfusionale, Azienda OspedalieroUniversitaria Consorziale Policlinico di Bari, Bari, Italy
2
UOSD and Research Unit of Thrombosis and Haemostasis, Fondazione IRCCS “Casa Sollievo Della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
3
Ob/Gyn Department of the First I.M. Sechenov, Moscow State Medical University, Moscow, Russian Federation
significant proteinuria (2092 mg/24 h), thus preeclampsia was diagnosed. In the following days, she showed blindness and a CS was performed at the 28th gestational week because of worsening of clinical conditions. Five days after CS, the woman showed tonic–clonic seizures (eclampsia) and large ecchymosis spread over entire body. She was admitted to the intensive care unit. Laboratory findings of hemolysis were observed, while coagulation tests and serum creatinine were within the normal range. A cerebral nuclear magnetic resonance described “….small ischemic corticalsubcortical cerebral vascular lesions recently appeared in the absence of intra-parenchymal hemorrhage”. Patient underwent 21 procedures of PEX and administration of methylprednisolone. A cardiac involvement with atrial and ventricular dilation with an ejection fraction of 35% was also found. Six days after the transfusions of RBC she showed a positive direct antiglobulin testing (DAT), with anti C3d and anti Jkb antibodies. The PEX led to clinical remission.
Ostuni (hematology‑transfusion me
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