A pregnant woman who had a simultaneous diagnosis of systemic lupus erythematosus and fetal and neonatal alloimmune thrombocytopenia (FNAIT) gave birth via an emergency cesarean section and was able to be discharged with her infant just a week later, according to a case report recently published in Cureus.
A 30-year-old woman who was pregnant for the second time was diagnosed with chronic idiopathic thrombocytopenia purpura at the age of 13 and received steroid therapy for eight years. Her first pregnancy proceeded uneventfully.
At 25 weeks of gestation, the patient was found to have a low platelet count of only 48,000/μL. Immune thrombocytopenia purpura was suspected, and she was administered steroids.
At 35 weeks of gestation, the patient had a spontaneous onset of labor. Laboratory investigations showed an extremely low platelet count of only 3,600/μL. The patient’s doctors assessed a significant risk of maternal-fetal hemorrhage, and a decision was made to perform an emergency cesarean section. Before the procedure was carried out, the patient received intravenous immunoglobulin G and platelet concentrate. Her platelet count remained below 20,000/μL—a critically low figure.
Read more about FNAIT testing and diagnosis
When she gave birth to her daughter, there were no notable external malformations. Nevertheless, out of an abundance of caution, the child was admitted into neonatal intensive care for close observation.
The infant experienced several notable medical episodes during her stay. For example, within the first day of life, the child developed conjunctival hemorrhage and apnea, for which she received supportive care. Platelet concentrates were transfused due to her low platelet count. There was no evidence of intracranial hemorrhage.
The child subsequently required hemodynamic stabilization. The most severe observation during the child’s hospital stay was possible early-onset neonatal sepsis, but she improved after she was given antibiotics. She was discharged after seven days.
Further testing on the mother revised her diagnosis of immune thrombocytopenia purpura to systemic lupus erythematosus, suggesting that the patient had an undiagnosed autoimmune disease, which may have contributed to the severely low platelet count observed in the newborn.
“This case exemplifies how a hematological manifestation in a newborn can reflect an unrecognized maternal immunological disorder, and how identifying it during the puerperium (ie, typically six weeks following delivery) can alter the diagnostic and therapeutic approach for both patients,” the authors of the report wrote.
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