A rare case of severe anemia with gestational thrombocytopenia
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 5
Abstract
Introduction: Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the lack of evidence available to guide for the diagnosis. 1) Anemia is the most common blood disorder in pregnancy. 2) Anemia secondary to iron deficiency is the most frequent hematologic complication, however care must be taken not to miss other causes of anemia, such as sickle cell disease and others. 3) The megaloblastic anemias due to folic acid deficiency, and to a lesser extent vitamin B12 deficiency, can also be a cause of anemia during pregnancy. 4) Thrombocytopenia is also a common reason for consulting the hematologist and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome, or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Case Report: 25 yrs old G4P2L2A1 with RH negative pregnancy came with a CBC report at 34 weeks showing severe anemia with normal platelet counts. Repeat investigations at 37 wks revealed severe anemia with thrombocytopenia. Patient had no signs of abnormal bleeding, petichae or bruises. Thorough investigations were done to rule out the causes like ITP, autoimmune haemolytic anaemia, HELLP syndrome, G6PD, sickle cell anaemia. Patient was transfused with 3 PCV. Patient was started with steroids and inj. Vit. K for 3 days but the platelet count remained persistently low in range of 47,000 to 64,000. On 7 day of admission the patient delivered a healthy female baby by caesarean section. On second post natal day the platelet counts were reported to be normal (plt- 2,16,000) and subsequently thereafter remained within normal limits. Here we present a rare case of severe anemia with gestational thrombocytopenia. Conclusion: It is a unique case of severe anemia with gestational thrombocytopenia with atypical presentation in which the platelet counts were below 70, 000, which caused diagnostic delima. With the entire team of obstetricians, haematologists and internal medicine we were able to successfully diagnose and manage this rare case.
Authors and Affiliations
Neha Bhatnagar, Archana Kumbhar
Keywords
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