Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

CASE REPORT

Systemic Lupus Erythematosus-associated Thrombocytopenia in Pregnancy: Is Splenectomy Necessary at the Time of Delivery?

Pasquale Martinelli, Marcello Granate, Filomena Quaglia, Giuseppe Cerciello, Corrado Marini

Citation Information : Martinelli P, Granate M, Quaglia F, Cerciello G, Marini C. Systemic Lupus Erythematosus-associated Thrombocytopenia in Pregnancy: Is Splenectomy Necessary at the Time of Delivery?. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):219-223.

DOI: 10.5005/jp-journals-10030-1195

License: CC BY 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Systemic lupus erythematosus (SLE)-associated thrombocytopenia in pregnancy is a rare condition associated with potential harm to the mother, the fetus, and/or newborn, if the thrombocytopenia is severe (<50,000/mm3). Controversy persists regarding the role and the timing of splenectomy in patients with SLE-associated refractory immune thrombocytopenia in pregnancy. This report describes the use of splenectomy at the time of the cesarean section (CS) in a patient with refractory SLE-associated thrombocytopenia.

Case report

A 19-year-old gravida 2, para 1 woman with SLE-associated thrombocytopenia diagnosed at age 16 developed a platelet count of 10,000/mm3 at the 18th week of gestation. She had been asymptomatic until that point, except for a previous spontaneous abortion at the 8th week of gestation in 2008. During this admission she was treated initially with methylprednisolone and enoxaparin, but following an episode of epistaxis she received intravenous immunoglobulin (IVIG). She was discharged home with a platelet count of 52,000/mm3. She was readmitted on the 34th week of gestation with a platelet count of 15,000/mm3 unresponsive to steroids and IVIG; she underwent a CS and an open splenectomy. Following surgery, she continued to receive maintenance dose steroids. She had a partial response to the splenectomy (platelet count on discharge 63,000/mm3).

Conclusion

Splenectomy at the time of CS is a safe therapeutic option for women with SLE-associated refractory thrombocytopenia during pregnancy.

How to cite this article

Granate M, Quaglia F, Petrone P, Cerciello G, Marini C, Martinelli P. Systemic Lupus Erythematosus-associated Thrombocytopenia in Pregnancy: Is Splenectomy Necessary at the Time of Delivery? Panam J Trauma Crit Care Emerg Surg 2017;6(3):219-223.

Antecedentes

La trombocitopenia asociada al Lupus Eritematoso Sistémico (LES) en el embarazo es una afección rara asociada con daño potencial a la madre, al feto y/o al recién nacido, si la trombocitopenia es grave (<50.000/mm3). La controversia persiste con respecto al papel y el momento de la esplenectomía en pacientes con trombocitopenia inmune refractaria asociada al LES en el embarazo. Este informe describe el uso de la esplenectomía en el momento de la cesárea (CS) en un paciente con trombocitopenia refractaria asociada al LES.

Caso

Paciente femenina de 19 años de edad, con trombocitopenia asociada a LES diagnosticada a los 16 años, gravida 2, para 1, desarrolló un recuento de plaquetas de 10.000/mm3 a la 18° semana de gestación. Hasta ese momento había estado asintomática, excepto por un aborto espontáneo previo a la 8° semana de gestación en 2008. Durante esta admisión se trató inicialmente con metilprednisolona y enoxaparina pero tras un episodio de epistaxis recibió inmunoglobulinas intravenosas (IVIG). Fue dada de alta con un recuento de plaquetas de 52.000/mm3. Fue readmitida a la 34° semana de gestación con un recuento de plaquetas de 15.000/mm3 no responde a los esteroides y IVIG. Se sometió a un CS y una esplenectomía abierta. Después de la cirugía, continuó recibiendo dosis de mantenimiento de esteroides. Tuvo una respuesta parcial a la esplenectomía (recuento de plaquetas al alta 63.000/mm3).

Conclusión

La esplenectomía en el momento del CS es una opción terapéutica segura para las mujeres con trombocitopenia refractaria asociada al LES durante el embarazo.

Antecedentes

A trombocitopenia associada ao Lupus Eritematoso Sistêmico (LES) na gravidez é uma condição rara associada a possíveis danos à mãe, ao feto e / ou ao recém nascido, se a trombocitopenia for grave (<50.000/mm3). A controvérsia persiste em relação ao papel e ao momento da esplenectomia em pacientes com trombocitopenia imune refratária associada ao LES na gravidez. Este relatório descreve o uso de esplenectomia no momento da cesariana (CS) em um paciente com trombocitopenia associada ao LES.

Caso

Paciente do sexo feminino, 19 anos, com trombocitopenia associada com LES diagnosticado aos 16 anos, grávida 2 a 1, desenvolveu uma contagem de plaquetas de 10.000/mm3 para a 18a semana de gestação. Até então ele tinha sido assintomática, com excepção de um aborto espontâneo antes às 8 semanas de gestação em 2008. Durante esta admissão foi inicialmente tratada com metilprednisolona e enoxaparina mas após um episódio de epistaxe receberam imunoglobulina intravenosa (IVIG). Ele recebeu alta com uma contagem de plaquetas de 52.000/mm3. Ele foi readmitido no 34a semana de gestação com uma contagem de plaquetas de 15.000/mm3 não responde aos esteróides e IVIG. Ele passou por uma CS e uma esplenectomia aberta. Após a cirurgia, ele continuou a receber uma dose de manutenção de esteróides. Ele teve uma resposta parcial a esplenectomia (contagem de plaquetas 63.000/mm3).

Conclusão

A esplenectomia no momento do CS é uma opção terapêutica segura para mulheres com trombocitopenia refratária associada ao LES durante a gravidez.


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