Management Challenges of Refractory Immune Thrombocytopenia during Pregnancy: A Case Report

Thrombocytopenia, characterised by a platelet count below 150,000/mu L, affects 7-11% of pregnancies for various reasons. Immune Thrombocytopenia (ITP), with platelet counts under 100,000/mu L, accounts for 1-4% of pregnancy-related thrombocytopenia cases, particularly in the first and second trimesters. Not all pregnant patients with ITP require treatment, but when necessary, corticosteroids and Intravenous Immunoglobulins (IVIGs) are commonly used. This case reports a 25-year-old pregnant female, G3A2, at 27 weeks of gestation with a history of ITP and hypothyroidism. She presented with severe thrombocytopenia (8,000/ mu L) and a history of petechiae and gum bleeding. Initial treatment included corticosteroids, IVIG, and platelet transfusions, leading to fluctuating platelet counts. Due to refractory ITP, advanced treatments such as rituximab and romiplostim were administered. Despite significant challenges, including an episode of epistaxis and the need for intensive monitoring, the patient delivered a healthy baby via normal vaginal delivery at 35 weeks. The newborn required brief respiratory support and phototherapy for jaundice but had stable platelet counts at discharge. This case highlights the complexity of managing refractory ITP during pregnancy, emphasising the need for a multidisciplinary approach and individualised treatment plans to ensure maternal and foetal wellbeing. Continuous vigilance, adaptive strategies, and the use of multidrug therapy were crucial in achieving a successful outcome, underscoring the importance of tailored protocols and emerging therapies in such high-risk pregnancies.