Management of Immune Thrombocytopenia via Splenectomy in a Full-Term Pregnant Woman: A Case Report

Thrombocytopenia in pregnancy is most commonly gestational. However, it is important to distinguish it from immune thrombocytopenia (ITP), which carries maternal and fetal risks. The treatment options include corticosteroids, intravenous immunoglobulin (IVIG), and splenectomy in refractory cases. A 38-year-old Syrian woman at 37 weeks of gestation with a history of 6 cesarean sections presented with refractory ITP. The patient's platelet count was 5.1×10³/mL despite receiving corticosteroids for a month. She underwent a cesarean section and splenectomy due to persistent severe thrombocytopenia (3×10³/mL) and labor onset. Pre- and intraoperative platelet transfusions were administered to reduce the bleeding risk. The procedure revealed an accessory spleen, and a healthy neonate was delivered with normal platelet counts. Maternal platelets improved after surgery to 115×10³/mL. First-line therapies such as corticosteroids and IVIG often suffice in ITP cases during pregnancies. Splenectomy is now viable for refractory cases, ideally in the second trimester. This case highlights the possibility of late-term splenectomy combined with the cesarean section in refractory cases to corticosteroids.