Idiopathic thrombocytopenic purpura in pregnancy refractory to corticosteroid therapy

Immune thrombocytopenic purpura (ITP) during pregnancy presents significant risks for both mother and fetus, with its management being complex due to its variable etiology and treatment limitations. We report a case of a 27-year-old woman in her fifth pregnancy who, at 26 weeks gestation, exhibited severe thrombocytopenia with a platelet count of 2000 units and spontaneous bruising. Despite corticosteroid therapy, her platelet count improved only marginally, and severe fetal growth restriction was noted. Attempts with eltrombopag were ineffective, leading to the decision to terminate the pregnancy at 35 weeks due to the need for immunoglobulin, which is contraindicated in pregnancy. The infant was born alive and did well, while the mother later required readmission for recurrent thrombocytopenia, which improved with additional immunoglobulin treatment. This case underscores the challenges of managing severe ITP during pregnancy and the need for coordinated care between obstetricians and hematologists.