妊娠合并难治性免疫性血小板减少性紫癜1例报告及文献回顾  

Refractory immune thrombocytopenic purpura during pregnancy:a case report and review of literature

作　　者：叶文凤 顾乔[1] 王超萍 朱丽华 薛春燕[1] 史丽娟 顾伟英[2] Ye Wenfeng;Gu Qiao;Wang Chaoping;Zhu Lihua;Xue Chunyan;Shi Lijuan;Gu Weiying(Department of Obstetrics and Gynecology,the First People's Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Suzhou 213004,Jiangsu,China;Department of Hematology,the First People's Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Suzhou 213004,Jiangsu,China;Department of Obstetrics and Gynecology,Shanghai Pudong New Area People's Hospital,Shanghai 201299,China)

机构地区：[1]常州市第一人民医院,苏州大学附属第三医院妇产科,江苏常州213004 [2]常州市第一人民医院,苏州大学附属第三医院血液科,江苏常州213004 [3]上海浦东新区人民医院妇产科,上海201299

出　　处：《实用检验医师杂志》2022年第1期97-100,共4页Chinese Journal of Clinical Pathologist

基　　金：江苏省卫生健康委妇幼健康科研项目(F201837,F201935)。

摘　　要：目的报告1例妊娠合并难治性免疫性血小板减少性紫癜(ITP)患者的处理过程,探讨难治性ITP的多学科治疗方法。方法常州市第一人民医院2019年12月17日收治1例妊娠合并难治性ITP患者,提示机体处于低凝状态,经治疗无明显效果,于孕28周时行剖宫产终止妊娠后血小板自行逐渐回升。结果患者为36岁妊娠女性,有血小板减少史10年未用药,怀孕以来血小板计数(PLT)逐渐降低,遂入院治疗。凝血功能检测提示患者处于低凝状态,给予多种治疗方法,包括地塞米松治疗血小板减少、补铁治疗贫血,给予血浆置换,去除血液中抗体物质和炎症因子,以及静脉输注丙种球蛋白、重组人血小板生成素、环孢素等,均无明显治疗效果。患者于孕28周时行剖宫产终止妊娠,血小板自行逐渐回升;术后3个月PLT恢复为孕前水平。结论ITP是妊娠期血小板减少的常见原因,难治性ITP的治疗需多学科联合,必要时考虑选择终止妊娠的最佳时机。Objective To report a case of pregnancy complicated with refractory immune thrombocytopenic purpura(ITP),and discuss the multidisciplinary treatment of refractory ITP.Methods On December 17,2019,a pregnant patient complicated with refractory ITP was admitted in the First People's Hospital of Changzhou,suggesting a low coagulation state.After treatment,there was no obvious effect.At the 28th week of pregnancy,after cesarean section and termination of pregnancy,the platelets level gradually rebounded.Results The patient was a 36-year-old pregnant woman with a history of thrombocytopenia and had not used drugs for 10 years.Since pregnancy,the platelet count(PLT)gradually decreased and was hospitalized.The detection of coagulation function showed that the patient was in a low coagulation state.A variety of treatment methods were given,including dexamethasone for thrombocytopenia,iron supplement for anemia,plasma exchange for the removal of antibody substances and inflammatory factors in the blood,and intravenous infusion of gamma globulin,recombinant human thrombopoietin,cyclosporine,etc.The patient underwent cesarean section to terminate the pregnancy at 28 weeks of pregnancy,and the platelet gradually recovered;PLT returned to the level of pre pregnancy after 3 months of operation.Conclusions ITP is a common cause of thrombocytopenia during pregnancy.The treatment of refractory ITP needs multidisciplinary cooperation,and the best time to terminate pregnancy should be considered when necessary.

关 键 词：难治性免疫性血小板减少性紫癜 多学科治疗 一线治疗 二线治疗 

分 类 号：R714.254[医药卫生—妇产科学]