ITP-Low Platecount

My Wife is suffering from ITP condition. Below I am mentioning about her issue in chronological events.

She is a 29 y/F with childhood diagnosis of ITP in India . At age 15 Marrow biopsy was done at that time. Short course of prednisone was used for 2-3 months only. She never was symptomatic after that for at least 10-12 years. She was also never tested again until age 27 (around 2007-2008).. During routine health evaluation she had low platelets at 30-40,000. No further investigations were done and no treatment was administered as she remained asymptomatic. No family history of hematologic disorders.


However, in November 2012, after she became pregnant, her platelets were 18,000. She was started on prednisone by a hematologist. Follow up counts were ~250,000 at 3 weeks and 80, 000 at 5 weeks. Then, they remained in the 20,000 range. In March 2013, she was given IVIG following which counts were ~150, 000 at 1 week and then decreased to ~20,000 at 2 weeks. Around this time she went into pre ecclapmsia and emergency C-section was performed at 27 weeks of gestation in March 2013. Platelets at this time were ~60-70000 post another IVIG. Child did not have any complications and is doing well.


2 weeks post C-section platelet counts decreased to 3000-4000. Treated with increased dose of prednisone and IVIG. Since there was no significant improvement, athough IVIG is increasing her count to 200,000 for 2 weeks. In May 2013, she was treated with 4 doses of Rituxan over 4 week period. She doesn't show much response to Rituxan, however she shows response to IVIG but it will last only for 2 weeks. Doctor is keeping her in stable condition by giving IVIG every 2-3 weeks. Throughout this ordeal, she remained and continues to remain asymptomatic from hematologic perspective. Her hematologist wants to try Nplate or splenectomy.