This paper describes a case of severe idiopathic thrombocytopenia in a
primigravida. The disorder became symptomatic at 22 weeks gestation with
a platelet count of 20,000/mu l. The existence of chronic idiopathic
thrombocytopenia under remission was strongly suspected, but could not
be documented. The patient was treated with oral corticosteroids over a
period of 7 weeks. During this period, she also had three cycles of
high-dose intravenous globulin. This treatment produced a transient
improvement, but the platelet count fell to 4,000/mu l by the 29th
gestational week. Caesarean section was carried out for maternal
indication a week later, following a fourth intensified course of
gamma-globulin, coupled with platelet transfusions and low-dose
vinblastine. Splenectomy was not performed. Potentially life-threatening
thrombocytopenia persisted for 6 weeks post partum. Despite the presence
of circulating antiplatelet globulin in the maternal blood and the
antenatal use of vinblastine, the infant was entirely unaffected and
thrived
