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A RARE CASE OF PREGNANCY WITH REFRACTORY ITP Dr Samiksha S Byakod , Dr Gauri Prabhu, Dr Anita Dalal Introduction Immune thrombocytopenic purpura (ITP; also termed idiopathic thrombocytopenic purpura) is an acquired disorder in which there is immune-mediated destruction of platelets and possibly inhibition of platelet release from the megakaryocyte. ITP occurs in one or two of every 1000 pregnancies and accounts for 5% of cases of pregnancy associated thrombocytopenia. Objectives A rare case of Refractory ITP diagnosed for the first time in pregnancy and to discuss the challenges encountered in the management Methods-Case study Patient was referred to our tertiary care hospital with persistent low platelet values and history of multiple blood transfusions. She is a Case of a 32 year old G5P2L2A2 with 35 weeks POG with cephalic presentation with refractory ITP with GDM on insulin , with platelets value of <60000, diagnosed at 31 weeks POG with h/o multiple blood transfusions, on clinical examination was pale, with overdistended uterus with mild splenomegaly on radiological examination . On evaluation all causes of thrombocytopenia were ruled out and diagnosis of ITP was established which was Refractory to steroid pulse therapy and Transfusions. Hence, drug therapy was initiated and patient responded well to the same. Results Pregnancy was terminated by preterm elective lSCS, a healthy female baby of 2.6kg born with uneventful intraoperative findings , treated with immunosuppressants Conclusion Refractory ITP in pregnancy is rare but a morbid condition which can have various differential diagnosis .Early diagnosis is a crucial in preventing unexpected complications and reducing maternal morbidity and mortality.