Administration of High Dose Immunoglobulin to a Pregnant Woman with Idiopathic Thrombocytopenic Purpura

Abstract

A 21-year-old pregnant woman was admitted to the hospital of Jichi Medical School in March 1984, with a history of petechiae on lower extrimities, and gingival and nasal bleeding. Physical examination revealed anemia, and petechiae on anterior chest and lower extremities. The platelet count was 7,000/μl. She was diagnosed as having a 17th week of pregnancy and idiopathic thrombocytopenic purpura by physical and laboratory findings. An administration of predonisolone (1 mg/kg/day) resulted in a transient increase in the number of platelets, so high-dose immunoglobulin (400 mg/kg/day) was given to the patient for 5 days from the 20th week of pregnancy. The number of platelets reached to a maximal level of 51,000/μl but the increase was only transient. Another two courses of immunoglobulin infusion and a course of prednisolone therapy (1.3 mg/kg/day) were repeated because of aggravation of bleeding tendency. However, those therapies failed to maintain the platelet count over 10,000/μl. The 4th course of high-dose immunoglobulin therapy was begun with an increase in the number of platelets (50,000/μl) and the patient underwent Caesarean operation in the 34th week of pregnancy. A baby-girl (2,695 g) was successfully obtained and a maternal splenectomy was done at the same time. The platelet level of the baby was normal. The platelet count of the patient was increased thereafter, reaching a level of more than 200,000/μl by 2 weeks after the procedures.