Primary immune thrombocytopenia (ITP) during pregnancy is an acquired autoimmune disorder characterized by a decreased platelet count (<100 × 10⁹/L) due to the presence of platelet-specific autoantibodies. Although ITP is rare, with an incidence of just 1–10 cases per 10,000 pregnancies, it poses significant risks of maternal hemorrhage and neonatal thrombocytopenia. Management options include first-line treatments such as corticosteroids and intravenous immunoglobulin (IVIG), while second-line therapies (high-dose steroids, or splenectomy) are reserved for refractory cases. Treatment is aimed at maintaining safe platelet thresholds (>30 × 10⁹/L during pregnancy and >50 × 10⁹/L for delivery) rather than achieving normal levels, thereby balancing maternal safety with fetal considerations. Multidisciplinary management involving hematologists, obstetricians, and neonatologists is essential for optimal outcomes.

6 primiparous women with severe ITP in late pregnancy (platelet count <20 × 10⁹/L) were treated with a comprehensive regimen including prednisone, recombinant human thrombopoietin, IVIG, and platelet transfusions, resulting in increased platelet counts (range of 48 to 294 × 10⁹/L). All 6 cases exhibited platelet counts <20 × 10⁹/L, gestational ages ranging from 32 to 34+ weeks, and were hospitalized for induction of labor.

Individualized comprehensive treatment can effectively manage severe ITP during late pregnancy, with protocols tailored to each patient’s condition, gestational age, and platelet count fluctuations.