ABSTRACT
OBJECTIVE: The article reviews the causes of thrombocytopenia in pregnancy and the basic examination scheme. Further, it deals in more details with diagnosis of immune thromocytopenic purpura (ITP) and presents a case report of a rare case of acute severe ITP in pregnant adolescent. DESIGN: Review article and case report. SETTINGS: Department Obstet/Gynecol Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem; Children and adolescent dep. Hospital Most; Institute of Hematology and Blood Transfusion Prague; Department of Children Med. Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem; Department of Clinic Hematology Masaryk´s Hospital, Ústí nad Labem; Department of Neonatology Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem. METHODS: Based on a review of the published papers, general rules for diagnosis, treatment, fetal risks, pregnancy management and labor in women with immune thrombocytopenic purpura (ITP) are given. Further we present the case of a 16-year-old pregnant girl with an acute severe form of ITP not responding to corticosteroid treatment who underwent twice critical decline of platelets up to 1×109 and repeatedly it was necessary to access the application of IVIG and Azathioprim (Imuran) was also used in her treatment. Pregnancy was unplanned terminated for dg. placental abortion in gestational age 32+4.The girl of 1740 g/42 cm was born with Apgar score 10-10-10 with no signs of thrombocytopenia. Surgery and postoperative course in the mother without complications. The newborn was discharged from the hospital into home care at a gestational age of 36+1 along with his mother. RESULTS: We present a case of acute severe form of ITP in pregnancy with a successful though somewhat dramatic end. CONCLUSIONS: These rare cases are demanding in terms of logistical, personnel and material provision. The aim of the treatment is to achieve a satisfactory maturity of the fetus, the treatment is financially demanding and is not without risks. Therefore, these cases should only be dealt with at Perinatology Centers in close cooperation with hematologists and neonatologists.
Subject(s)
Pregnancy Complications, Hematologic , Purpura, Thrombocytopenic, Idiopathic , Thrombocytopenia , Adolescent , Female , Gestational Age , Humans , Infant, Newborn , Parturition , Pregnancy , Pregnancy Complications , Pregnancy Complications, Hematologic/blood , Pregnancy Complications, Hematologic/therapy , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/therapy , Risk Factors , Treatment OutcomeABSTRACT
Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.
