FRCPath Haem Part 1 MCQs-General Haem 478

A 29-year-old woman with known immune thrombocytopenia (ITP) is admitted at 39+1 weeks' gestation with painful uterine contractions and ruptured membranes. She is in established labour.

Her pregnancy has been managed jointly by obstetric, haematology and anaesthetic teams. She has received prednisolone during pregnancy with a suboptimal response.

On admission:

• Hb: 108 g/L

• WCC: 9.8 × 10⁹/L

• Platelet count: 20 × 10⁹/L

• LFT and renal function: normal

• No active significant bleeding

The obstetric team is planning vaginal delivery. The patient requests an epidural for analgesia.

Which of the following is the most appropriate management plan?

A. Proceed with epidural anaesthesia and vaginal delivery

B. Give one adult therapeutic dose of platelets immediately to achieve a platelet count >70 × 10⁹/L before epidural anaesthesia

C. Perform emergency caesarean section because the platelet count is <50 × 10⁹/L

D. Give IVIG 1 g/kg, IV methylprednisolone 250 mg and IV tranexamic acid 1 g

E. Give oral prednisolone and repeat the platelet count in 24 hours

F. Platelet Transfusion  and Tranexamic acid