Cesarean Section Combined with Splenectomy for Refractory Immune Thrombocytopenic Purpura

Objective: The major treatment options for immune thrombocytopenic purpura (ITP) are corticosteroids or intravenous immunoglobulin. If the patient fails to respond to medical treatment, splenectomy should be considered. Case Report: A 27-year-old pregnant woman, gravida 2, para 1, was referred to our hospital because of ITP at 35 weeks' gestation. Steroid therapy had been prescribed (75 mg/day prednisolone) since 31 weeks' gestation, but no response was observed. The patient was admitted to our ward due to premature rupture of membranes at 36 weeks' gestation, and cesarean section was performed as she had had a previous cesarean section. After delivery of the infant, splenectomy was performed as definitive therapy for her ITP. The patient's initial postoperative course was uneventful; the platelet count on the follow-up visit 6 weeks later was 109,000 cells/mL. Conclusion: ITP should be managed with steroid therapy or intravenous immunoglobulin. When these fail, splenectomy may be the only remaining option.