Greer, O

Mallam, L

Ofili-Yebovi, D

English

Spiral - Imperial College Digital Repository

18/21 OCTOBER 2017BARCELONA FOLLOW US!@ESGYNECOLOGYESGYNECOLOGY.orgP149. IDIOPATHIC THROMBOCYTOPENIA- CAN A DIAGNOSIS OF EXCLUSION REALLYBE DIAGNOSED?Mallam L  (GB) [1], Greer O  (GB) [2], Ofili-Yebovi D  (GB) [3]Context We present a challenging case of profound thrombocytopenia in pregnancy following initial presentationwith severe hyperemesis gravidarum (HG). Investigations led to a working diagnosis of exclusion,idiopathic thrombocytopenia (ITP). ObjectiveIn this report, we describe the clinical presentation prior to the multi-disciplinary challenge ofinvestigating severe thrombocytopenia. We evaluate current guidance on the diagnosis andmanagement of ITP. We also hypothesize, nutritional deficiencies may play a crucial role in thedevelopment of profound thrombocytopenia at such an early phase in pregnancy. The risk ofspontaneous haemorrhage in pregnancy with platelet counts less than 20 x109/L can be significant andis associated with inherent morbidity/ mortality to mother and child; the correct diagnosis andmanagement is imperative.MethodRetrospective case reportPatientA 46-year old multiparous Eritrean lady presented at 7-weeks’ gestation with a 2-week history of severeHG. She also reported over 10% loss of body weight and epigastric pain.Intervention & resultsOn admission, all electrolytes and blood counts were within normal ranges, with a platelet count of 150x109/L. An ultrasound scan showed an intrauterine pregnancy and 8cm subchorionic haematoma whichshowed resolution on subsequent imaging. After an unsuccessful trial of several anti-emetic therapies, the addition of intravenous steroid therapywas successful. She then entered a prolonged period of refeeding syndrome, with a potassium nadir of[1] Chelsea & Westminster Hospital NHS Foundation Trust, [2] Chelsea & Westminster Hospital NHS Foundation Trust, [3] Chelsea & Westminster Hospital NHSFoundation Trust2.7 mEq/L. As her presenting symptoms resolved, her platelet count suddenly deteriorated from 140 to 15 x109/L.She was trialled on immunoglobulin therapy with no response and showed a very muted response tohigh dose steroids. Extensive investigations inclusive of bone-marrow biopsy, viral and auto-immunescreen and assessment for Haemolytic Uraemic Syndrome/ Thrombotic Thrombocytopenic Purpurafailed to identify establish an alternative diagnosis; a presumptive diagnosis of ITP was made. DiscussionWe describe a case of profound thrombocytopenia complicating first trimester pregnancy. Wedemonstrate the challenges in reaching a diagnosis which is made by exclusion but so far fails toadequately respond to standard ITP treatment. Although the result remains unsatisfactory, this casehighlights the diverse aetiology of thrombocytopenia and the importance of a multidisciplinary approachwith close monitoring of both mother and child.

P149. Idiopathic thrombocytopenia- Can a diagnosis of exclusion really be diagnosed?

http://spiral.imperial.ac.uk/bitstream/10044/1/95845/2/abs6436.pdf

P149. Idiopathic thrombocytopenia- Can a diagnosis of exclusion really be diagnosed?

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