ITP diagnosed while preg

I was diagnosed with ITP with 8000 count in the 9 month of preg.

my gyno completely ignored my blood counts all through my preg and luckily she atleast read the blood count before inducing me and sent me to a University hospital.

They did put me on pred and IVgs for 4 days before inducing me and L&D went fine and blessed with a beautiful daughter.
My count while discharing me was around 100k and they released with 60 mg for 2 weeks.

Tapered from 80 mg.

Just today, I had my Hemo appointment for checking on my count and quite surprisingly the tapering is acting -ve

It decreased the count to 80k, now the Dr. is giving me two options which I would like to know what you guys think?

1. keep tapering pred and monitor me every other week for blood count
2. if the count gets below 50k
1. check for bone marrow
and cut the spleen.

what do you think of this agressive approach?

And he is department head for Hemo department at our state univ in Mississippi.

Please help me out.

The rush to spleenectomy seems a little aggressive. I'm not a medical professional, but you might want to give your body a chance to adjust from the pregancy hormones and birth before making a non-reversable decision, especially if you're nursing. Since the prevalance of autoimmune diagnosis run something like 4 or more women for every man, I'd say there a good chance that hormones may play some role in the course of the progression of auto-immune conditions.

I won't let his title scare you into a decision you're not comfortable with. Head of department may mean he's got more experience with the "old" school treatments of predisone and spleenectomy and more stature to lose by adopting new approaches if they don't work out. Just a couples of weeks ago, I was on the phone with a cousin who has multiple medical complications at 47 from having diabetes since she was 12, whose University Medical hemo kept telling her the spleenectomy was the best solution even though she was HIGH risk with heart issues and diabetes for surgery. She gave in because the pred side effects overall(especially to her blood sugars) were so nasty and now 4 months later it's failed.

Number two on your list is a bit worrying. Nobody, but nobody would do a splenectomy at a count of 50. More like under 20. And there are other treatments to try if you'd rather not go that route.

www.pdsa.org/treatments/conventional.html
That's the PDSA's conventional treatment page - there is also a page for complementary treatments. If you haven't checked out all the treatments you might want to do so.

Congratulations on the birth of your daughter!

Way too aggressive at this point in time. There are quite a few other valid options in there.

Thank you all!
It feels secure to hear some replies.

If I missed any points of my diagnose here is my case in brief:

1.always had heavy periods
2.throughout my pregnancy my platelets were ignored(by my gyno Dr. ) but here are the numbers from my medical records
1. @ 2 months 48k
2. @ 28 weeks 28k
3. @ 38 weeks 11k
@ sent to bigger town while inducing labor , count went admitted into bigger was 8k

-- no symptoms of bleeding or gum bleeding

I would like to know whether this is common at 8k without any symptoms of bleeding.

4. immediately put me on immunogl..
5. gradually got me to 88k and I went into labor naturally
6. put me on preds while discharging me
7. started to loose black blood from pregnancy everyday
8. last checked count 80k with 60 mg of pred
9. dose tapered to 50 mg for 1 week, and then further tapered until 20 mg

I have my next appointment on 25th of this month.

Please help me to ask right questions? and the staff(nurses) are real bad at Univ hospital but Dr. is OK.

Do I need to change the Dr.?

Congrats on your little one!!

Mine was also triggered by preg and no one said a thing. Luckily my counts did not go down too far. I have since gotten all my records and blood tests from before , during, and after.

Since then, they dropped again after I had a mercury filling taken out. Then they dropped again when I was under terrible stress and could not sleep for about 2 weeks.

THey are now monitoring me, thankfully. I have a very good hemo.

It has been ten years, so I am holding.

I hope yours resolves soon. I have heard that most gestational thrombocytopenia DOES resolve in about a year.....I would DEFINATELY give it time, but with lots of research under your belt, warning signs, etc. The people here know so much and there are many web sites.

Have a great night with your new baby!

Hi,

I was also recently diagnosed with ITP at 35 weeks. My count dropped from 121k to 58k. I had been planning a natural home water birth for our first child, but am now told this is going to be a medical birth, not a natural one. We are now trying to decide whether it is safer for myself and the baby to be induced or to have a scheduled c-section. The OB I was referred to got called into surgery just before my appointment, so he didn't get a chance to talk to us for long. I know he wants to start treatment for upping my platelets, but I don't know what he has in mind for treatment. We didn't get that far. Does anyone have any advice? Are there questions that I should be asking of the OB when I see him next week? They sent me for more blood work...and he ruled out preeclampsia as the cause of the ITP...my BP at it's highest is only 110/58.
This is my first pregnancy, we're having a little boy and very excited, but this news has kinds rocked me. I don't know what I should do about how to deliver. Or if meds are going to be bad for the baby. It's all kinda scary.

are you RH negative? COuld that be a cause? I am Rh negative and always wondered if the Rhogam may have caused it....

Rhogam is anti-D and anti-D is often used as a treatment for ITP so I doubt that it would have triggered ITP, but you never know.

Laraj:

The treatment you received sounds normal and just. It's just now that I'd question the aggressive approach. I think it would be beneficial to read through the treatments and ask your doctor about those. A second opinion couldn't hurt.

We also forget that the opinion of the doctors is still that splenectomy is a good second line treatment, after prednisone. Most of them still think of it as a good risk to take. It's us, the patients, who are no longer as keen and not as likely to just go along with it as we used to be. So don't imagine that your doctor is doing anything different by suggesting splenectomy at this stage. Just be aware of your options and that you are allowed to have input in the decision.

No, I'm Rh positive...haven't heard anything else yet about what's going on. See the OB on Tuesday...

Hi again, no I'm Rh negative. So it can't be that.

The RH factor has nothing to do with an ITP diagnosis. Neither does your blood type. It all has to do with antibody production which comes from B cells and T cells (a type of white cell). Well, that's the simple explanation.