Refractory Thrombocytopenia in a 29-Year-Old Pregnant Woman With Autoimmune Hepatitis: A Case Report and Literature Review

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 11; p. e49189
• Main Authors: Al-Sum, Hythem A, Alsurori, Suhad M, Alkhlassi, Maha N, Alanazi, Albandari A, Alkhlassi, Ibtisam N, Alkhlassi, Salma N
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 21.11.2023; Cureus
• Subjects: Allergy/Immunology; Blood platelets; Case reports; Cesarean section; Childbirth & labor; Fetuses; Gestational age; Hematology; Hemoglobin; Hepatitis; Liver cirrhosis; Liver diseases; Mortality; Obstetrics/Gynecology; Patients; Postpartum period; Pregnancy; Remission (Medicine); Thrombocytopenia; Womens health; aih -autoimmune hepatitis; autoimmune hepatitis with cirrhosis; aih; autoimmune hepatitis in pregnancy; refractory thrombocytopenia; thrombocytopenia in pregnancy
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.49189

Autoimmune hepatitis (AIH) is a rare autoimmune liver disease that mostly affects women in their reproductive years, leading to impaired fertility. Nonetheless, the majority of women with well-controlled AIH have a favorable prognosis for pregnancy. This case report describes a 29-year-old pregnant woman with cirrhosis secondary to AIH who presented with severe thrombocytopenia. Her labs showed a decline in her platelet counts from 28 × 10 /L before pregnancy to 20 × 10 /L during pregnancy. Her abdominal ultrasound showed liver cirrhosis secondary to AIH and splenomegaly. Throughout pregnancy, various scans were performed to monitor the fetal well-being, which showed normal results. She was on a medication regimen that included nadolol of 80 mg/kg/day, prednisolone of 5 mg/kg/day, and azathioprine of 50 mg/kg/day. Due to a breech presentation, the patient was scheduled for a cesarean section. She received two courses of dexamethasone at 20 mg/day for four days within two weeks of delivery. On the day of her scheduled C-section, tranexamic acid of 1 g TID for two days was administered, and she received platelet transfusions of 12 units both before and after the procedure, with an additional 6 units administered during the procedure. Despite proper management, her platelet count remained consistently low. However, she successfully delivered a healthy baby, and the overall condition of the patient was stable.