A Case Report of Pregnancy Complicated with Thromboasthenia
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We report a case of pregnancy and delivery of a thromboasthenic woman, who had history of frequent blood transfusions and had anti-platelet antibody (anti-Plt Ab) in her serum.A patient was a 25 year-old primigravida. She was diagnosed as thromboasthenia at 7 years of age, and because of recurrent massive bleeding was transfused many times from her four brothers. She became pregnant and consulted our department.Before delivery, we evaluated her anti-Plt Ab by LCT (lymphocyte toxicity test), AHG-LCT (anti-human globulin lymphocyte toxicity test), and MPHA (mixed passive hemagglutination using platelet), but we could not detect it. Her two brothers were prepared as Plt donors in whose serum no anti-Plt Ab was detected by LCT and MPHA. When the induction of delivery was begun, 27U Plt obtained from the donors was transfused to her. Nevertheless, her Plt count and bleeding time (BT) didn't improve at all. After the donor's 10U Plt and random donors' 70U Plt were transfused, her Plt count, BT and Plt aggregation by ADP were improved, and she delivered a 3620g mature female uneventfully. Bleeding amount was 950ml. Genital bleeding was increased at 3 weeks after delivery, and she fell into severe anemia. 220U Plt and 5U CRC were transfused, but Plt count and BT were not improved at all. Prostaglandin F2α was injected into uterine cervix and ovserved. Thereafter genital bleeding was decreased gradually. After delivery, her serums obtained before and after delivery was examined by sensitive MACE (modified antigen captured ELISA). It revealed that anti-Plt Ab was present in both serum.Thromboasthenic patient who has history of blood transfusion has the possibility of the presense of anti-Plt Ab in his serum. We shold be careful for false-negative results of the examinations of Anti-Plt Ab. Moreover we should take care of bleeding not only at delivery but also at puerperum.
- 一般社団法人 日本血栓止血学会の論文
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