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Vincristine for refractory autoimmune thrombocytopenic purpura in pregnancy. A case report
Z Gross1, J J Rodriguez, B L Stalnaker
1Department of Obstetrics and Gynecology, University of Florida College of Medicine, Pensacola 32503, USA.
Background:
Autoimmune thrombocytopenic purpura is a common disease during pregnancy. Newborns of affected mothers commonly develop thrombocytopenia. Standard therapy consists of corticosteroids, hyperimmune gamma globulin and splenectomy.
Case:
Severe autoimmune thrombocytopenic purpura was diagnosed in a 22-year-old woman, gravida 2, para 1, at 28 weeks' gestation. A sufficient response was obtained after vincristine was added to the treatment with corticosteroids, hyperimmune gamma globulin and danazole. A male infant weighing 2,545 g was delivered by cesarean section at 33.5 weeks' gestation. There were no maternal or fetal complications except for severe newborn thrombocytopenia, which resolved with medical therapy.
Conclusion:
Vincristine has been used in all trimesters of pregnancy, with favorable outcomes in most cases. This is the first reported case of successful vincristine treatment for autoimmune thrombocytopenic purpura in pregnancy. Vincristine, when carefully used, offers an option for unusually refractory cases of autoimmune thrombocytopenic purpura before delivery.