臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
症例
妊娠中期より免疫グロブリン大量療法を試みた血小板減少性紫斑病の1例
小松 則夫吉田 信彦坪山 明寛久保田 一雄坂本 忍三浦 恭定
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1985 年 26 巻 9 号 p. 1481-1485

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A 21-year-old pregnant woman was admitted to the hospital of Jichi Medical School in March 1984, with a history of petechiae on lower extrimities, and gingival and nasal bleeding. Physical examination revealed anemia, and petechiae on anterior chest and lower extremities. The platelet count was 7,000/μl. She was diagnosed as having a 17th week of pregnancy and idiopathic thrombocytopenic purpura by physical and laboratory findings. An administration of predonisolone (1 mg/kg/day) resulted in a transient increase in the number of platelets, so high-dose immunoglobulin (400 mg/kg/day) was given to the patient for 5 days from the 20th week of pregnancy. The number of platelets reached to a maximal level of 51,000/μl but the increase was only transient. Another two courses of immunoglobulin infusion and a course of prednisolone therapy (1.3 mg/kg/day) were repeated because of aggravation of bleeding tendency. However, those therapies failed to maintain the platelet count over 10,000/μl. The 4th course of high-dose immunoglobulin therapy was begun with an increase in the number of platelets (50,000/μl) and the patient underwent Caesarean operation in the 34th week of pregnancy. A baby-girl (2,695 g) was successfully obtained and a maternal splenectomy was done at the same time. The platelet level of the baby was normal. The platelet count of the patient was increased thereafter, reaching a level of more than 200,000/μl by 2 weeks after the procedures.

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© 1985 日本臨床血液学会
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