ITP

Question 1

CRITO Immune thrombocytopaenia

Answer 1

Condition: maternal anti-platelet antibodies leading to low maternal platelet levels; can cross placenta.

Risks: maternal haemorrhage; fetal thrombocytopaenia and haemorrhage.

Investigations:

• FBC
• Exclude HELLP/PET
• Exclude ALPS/SLE: ANA, anti-dsDNA, anti-cardiolipin, lupus anticoagulant, anti-B2 glycoprotein-1
• Exclude infection

Treatment:

• Maintain Plts >20:
  
  • Steroid prednisolone 20-30 mg daily
  • IVIG 1g/kg
  • (Splenectomy 2nd trimester ideally)
  • (Platelet transfusion)

Ongoing management:

• Monitor Plt count monthly until 36 weeks then weekly until delivery.
• Plts need to be:
  
  • >20 to prevent spontaneous haemorrhage
  • >50 to prevent haemorrhage
  • >80 for regional anaesthesia
• Fetus/neonate:
  
  • Avoid FSE, FBS, instrumental
  • Cord bloods: Plt count, DAT
  • Monitor for at least 2-5 days.