Journal of obstetrics and women's diseasesJournal of obstetrics and women's diseases1684-04611683-9366Eco-Vector692210.17816/JOWD66479-83Research ArticleThe case of abdominal delivery in acute heteroimmune drug indused thrombocytopeniaShirokovDmitriy M.<p>MD. Head of the of Anesthesiology department</p>dm_shirokov@interzet.ruBolotskikhVyacheslav M.<p>PhD Deputy director for medical work</p>docgin@yandex.ruDzhanashiaManana M.<p>MD. Head of Pregnancy Pathology Department No 2</p>manana.ott@yandex.ruEremeevaDina R.<p>MD. obstetrician-gynecologist of Pregnancy Pathology Department No 2</p>dina-bikmullina@yandex.ruKorostelevYury M.<p>MD. anesthesiologist</p>juko_71@mail.ruVartanovaIrina V.<p>MD. anesthesiologist</p>ivartanova@mail.ruBlinovAleksey E.<p>internist anesthesiologist</p>79046408390@yandex.ruOtt Research Institute of Obstetrics, Gynecology and ReproductologySaint Petersburg Pavlov State Medical UniversityKirov Military Medical Academy15072017664798315072017Copyright © 2017, Shirokov D.M., Bolotskikh V.M., Dzhanashia M.M., Eremeeva D.R., Korostelev Y.M., Vartanova I.V., Blinov A.E.2017<p>The secondary gravida pregnant patient with uterine scar after previous cesarean section was treated with parenteral methamizol sodium due to renal colic and acute thrombocytopenia suddenly occurred. There were supposed that this condition had been drugs induced heteroimmune thrombocytopenia. The indications for planned cesarean section were breech presentation of large fetus in patient with uterine scar. However, uterine contractions appeared in 38/39 weeks and it was decided to deliver the patient urgently after appropriate preparing. The treating of severe thrombocytopenia was substitutive thromboconcentrate and plasma transfusion and pathogenetic using of dexamethasone and human immunoglobulin. After transfusion of one dose of thromboconcentrate and two doses of plasma the level of thrombocytes had reached of 21 109/л and it was decided to start cesarean section which was performed successfully in conditions of total combined anesthesia with tracheal intubation and pulmonary ventilation. The recovery of thrombocytes quantity occurred in postoperative period with continuing using of steroid therapy.</p>pregnancymethamizol sodiumthrombocytopeniaбеременностьметамизол натриятромбоцитопения[1. Bowersox NA, et al. Thrombocytopenia in Pregnancy. Medscape. 2016. http://emedicine.medscape.com/ article/272867-overview][2. Ушкалова Е.А., Астахова А.В. Проблемы безопасности анальгина // Фарматека. – 2003. – № 1 (64). [Ushkalova EA, Astahova AV. Problemy bezopasnosti anal’gina. Farmateka. 2003:1(64). (In Russ).]][3. Redondo-Pachon MD, Enriquez R, et al. Acute renal failure and severe thrombocytopenia associated with metamizole. Saudi J Kidney Dis Transpl. 2014;25(1):121-5.][4. Kessler CM, et al. Immune Thrombocytopenic Purpura (ITP). Medscape. 2016. http://emedicine.medscape.com/article/202158-guidelines.][5. Rajasekhar A, Gernsheimer T, et al. Clinical Practice Guide on Thrombocytopenia in Pregnancy / American Society of Hematology. Washington; 2013.][6. Кузьмин В.Н., Серобян А.Г. Острый жировой гепатоз беременных в практике акушера-гинеколога // Лечащий врач. – 2003. – № 5 (03). [Kuz’min VN, Serobjan AG. Ostryj zhirovoj gepatoz beremennyh v praktike akushera-ginekologa. Lechashhij vrach. 2003;5(03). (In Russ).]][7. Меликян А.Л., Пустовая Е.И., Цветаева Н.В, и др. Национальные клинические рекомендации по диагностике и лечению первичной иммунной тром боцитопении (идиопатической тромбоцитопени ческой пурпуры) у взрослых // Гематология и трансфузио логия. – 2015. – T. 60. – № 1. – C. 44–56. [Meli kyan AL, Pustovaya EI, Tsvetaeva NV, et al. National clinical recommendations for diagnosis and therapy of idiopathic thrombocytopenic purpura (primary immune thrombocytopenia) in adults. Hematology and Transfusiology. 2015;60(1):44-56 (In Russ).]][8. Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc. 2004 Apr;79(4):504-22. doi: 10.4065/79.4.504][9. Hansen RJ, Balthasar JP. Mechanisms of IVIG action in immune thrombocytopenic purpura. Clin Lab. 2004;50(3-4):133-40.][10. Sullivan CA, Martin JN Jr. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol. 1995;38(3):521-34.]