Rare Blood Disorder Pregnancy Jj Hospital Woman Baby

A 32-year-old woman from Jalna district, who had lost three full-term newborns within days of birth over the past several years, has delivered a healthy baby after doctors at Mumbai’s Grant Government Medical College and Sir JJ Group of Hospitals diagnosed and managed a rare combination of blood disorders during her pregnancy.

The case, published this month in the Journal of South Asian Federation of Obstetrics and Gynaecology, highlights how serious blood disorders can go undiagnosed for years, particularly among women in rural areas with limited access to specialist care.

The woman was referred to JJ Hospital at 37 weeks and five days of pregnancy with a platelet count of just 15,000 per microlitre of blood, far below the normal level of over 150,000 and placing her at high risk of severe bleeding during childbirth.

What immediately concerned doctors was her obstetric history. She had delivered three full-term babies — two boys and a girl — but all had died within seven to ten days of birth. During each pregnancy, she had required repeated blood and platelet transfusions and had been told she suffered from a bleeding disorder, yet no detailed haematological evaluation had ever been carried out.

“When she came to us, we knew immediately that she was at extremely high risk because her three babies had died earlier and she had a history of a bleeding disorder, but there were no documents and no formal diagnosis,” said Dr Pratiksha D Khamkar, one of the study’s authors. “We had to manage a very high-risk pregnancy with a platelet count of only 15,000.”

Doctors initially suspected Immune Thrombocytopenic Purpura (ITP), an autoimmune disorder in which the body destroys its own platelets. However, she also developed features of HELLP syndrome, a severe pregnancy complication involving haemolysis, elevated liver enzymes and low platelet counts. Laboratory findings further raised concerns about Thrombotic Thrombocytopenic Purpura (TTP), a rare and potentially fatal blood disorder.

“The difficulty was that all the features were overlapping. There are two important conditions involving platelets — ITP and TTP. In pregnancy, both seemed to be present. It was difficult to clearly identify which one was responsible for her condition,” Dr Khamkar said.

A key clue emerged when her platelet count showed little improvement despite transfusions. Doctors then administered intravenous immunoglobulin (IVIG), after which her platelet count rose significantly, suggesting an underlying immune-mediated disorder.

As doctors worked towards a diagnosis, the foetus began showing signs of distress. Monitoring revealed a non-reactive non-stress test and meconium-stained amniotic fluid, prompting an emergency caesarean section despite the substantial risk of bleeding.

The surgery was complicated by severe haemorrhage. The patient developed uterine atony, a condition in which the uterus fails to contract after delivery, forcing surgeons to perform bilateral uterine artery ligation to control the bleeding.

Despite the complications, doctors successfully delivered a healthy baby girl weighing 2.4 kg in May 2025. It was the first time one of the woman’s babies had survived.

The mother’s condition remained critical after delivery. Her blood pressure rose sharply to 170/110 mm Hg and a CT scan later revealed Posterior Reversible Encephalopathy Syndrome (PRES), a neurological condition associated with severe hypertension.

Further investigations suggested a high probability of TTP based on her PLASMIC score, a clinical tool used to assess the likelihood of the disorder. However, doctors concluded that several aspects of her condition did not fit the diagnosis and decided against plasma exchange therapy. Subsequent tests ruled out TTP, and clinicians increasingly suspected long-standing, undiagnosed chronic ITP complicated by HELLP syndrome during pregnancy. The diagnosis was reinforced when her platelet count improved significantly following steroid treatment.

During her hospital stay, she received 22 units of platelets, five units of packed red blood cells, six units of fresh frozen plasma and four units of whole blood. Even after delivery, complications continued, with her surgical wound failing to heal properly and requiring prolonged treatment.

After spending more than a month in hospital, she was discharged with improving platelet counts and advised long-term follow-up with a haematologist.