Recurrent severe gestational thrombocytopenia in pregnancy
Most of the newly diagnosed cases of thrombocytopenia in pregnancy are mild, asymptomatic and accidentally discovered on routine antenatal screening. Common causes for the same include gestational thrombocytopenia, Preeclampsia, HELLP syndrome, and less commonly immune causes like ITP. As a matter of fact, HELLP and Preeclampsia have specific diagnostic signs and symptomatology, others are rather difficult to distinguish, as they are usually asymptomatic.

Published in the International Journal of Advances in Medicine, the authors present a case of 21 years second gravida at 35 weeks and six days period of gestation, referred from a local practitioner for severe thrombocytopenia (Platelet count-20000/mm3). She had history of previous still birth due to cord prolapse, and severe thrombocytopenia (Platelet count-6000/mm3) in previous pregnancy. She recovered rapidly and spontaneously in postpartum period.

The newborn platelet count was also normal. She was considered to be a case of rare but severe recurrent gestational thrombocytopenia, after ruling out other causes of severe thrombocytopenia in pregnancy.

Case takeaways:-
• To distinguish between ITP and Gestational Thrombocytopenia in case of newly diagnosed severe thrombocytopenia is difficult.

• In this case, not only the clinical picture was contrasting, history also was of no valuable help. Final conclusion could only be reached after postpartum surveillance.

• As far as management is concerned, both the entities are to be treated in the same manner, especially in cases of severe grades, so as to maintain the safe level of PLT for styptic measures and other serious causes should be ruled out simultaneously. Management includes adequate preparations for ensuring optimal fetomaternal outcome.

• Treatment initiation and modification should be done, with preparation and anticipation for regional anesthesia, blood loss and appropriate styptic measures.

• Neonatal screening is recommended in such cases.

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