Clinical Features and Treatment Strategies for Primary Immune Thrombocytopenia in Late Pregnancy: An Analysis of Six Cases

Background: Primary immune thrombocytopenia (ITP) during pregnancy is an acquired autoimmune disorder characterized by a decreased platelet count (<100 × 109/L) due to the presence of platelet-specific autoantibodies. Although ITP is rare, with an incidence of just 1–10 cases per 10,000 pregnancies, it poses significant risks of maternal hemorrhage and neonatal thrombocytopenia. Management options include first-line treatments such as corticosteroids and intravenous immunoglobulin (IVIG), while second-line therapies (high-dose steroids, or splenectomy) are reserved for refractory cases. Treatment is aimed at maintaining safe platelet thresholds (>30 × 109/L during pregnancy and >50 × 109/L for delivery) rather than achieving normal levels, thereby balancing maternal safety with fetal considerations. Multidisciplinary management involving hematologists, obstetricians, and neonatologists is essential for optimal outcomes. Case: 6 primiparous women with severe ITP in late pregnancy (platelet count <20 × 109/L) were treated with a comprehensive regimen including prednisone, recombinant human thrombopoietin, IVIG, and platelet transfusions, resulting in increased platelet counts (range of 48 to 294 × 109/L). All 6 cases exhibited platelet counts <20 × 109/L, gestational ages ranging from 32 to 34+ weeks, and were hospitalized for induction of labor. Conclusions: Individualized comprehensive treatment can effectively manage severe ITP during late pregnancy, with protocols tailored to each patient’s condition, gestational age, and platelet count fluctuations.