RATIONAL COMBINATION THERAPY WITH SIMULTANEOUS OPERATIONS FOR REFRACTORY IMMUNE THROMBOCYTOPENIA AND DURING PREGNANCY

Background. Thrombocytopenia may complicate the course of up to 10% of pregnancies. Above 70% of the first detected thrombocytopenia cases are directly related to pregnancy. Glucocorticoid therapy in average daily therapeutic doses of 0.5-0.7 mg/kg is a basic treatment during pregnancy and for immune thrombocytopenia. Splenectomy is the basis for second-line therapy during pregnancy. Description. The paper describes two clinical cases of pregnant women with thrombocytopenia who underwent laparoscopic splenectomy after cesarean section. Both patients preoperatively received prednisolone and human immunoglobulin. In the first 24 hours after surgery, there was an increase in platelets from 28,000 to 111,000 in one woman and from 9х10 9 to 13х10 9/l in the other. The latter underwent cesarean section and laparoscopic splenectomy during reinfusion of autoerythrocytes and transfusion of 1000 ml of fresh frozen plasma and 8 doses of platelet concentrate. Outpatient romiplostim therapy that could maintain partial remission for 14 months was additionally performed. Conclusion. Simultaneous laparoscopic splenectomy during surgical delivery in pregnant women with severe refractory immune thrombocytopenia is effective and maximally safe due to its low invasiveness, less expected blood loss, and rapidest postoperative recovery as compared to an open access.

thrombocytopenia, pregnancy, splenectomy