Anesthesia management of cesarean delivery in primary Sjögren’s syndrome complicated by severe immune thrombocytopenia: A case report

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease that may be complicated by secondary immune thrombocytopenia (ITP), posing substantial risks during pregnancy, particularly regarding anesthetic management. A 25-year-old primigravid woman with pSS-associated secondary ITP developed progressive thrombocytopenia with a nadir platelet count of 13 × 10 ⁹ /L in late pregnancy. Given the profound thrombocytopenia, active cutaneous petechiae, and high bleeding risk, neuraxial anesthesia was contraindicated. An elective cesarean section was successfully performed under general anesthesia using an esketamine-based rapid-sequence induction protocol with perioperative platelet transfusion. Maternal and neonatal outcomes were favorable, with no hemorrhagic complications and Apgar scores of 9 and 10 at 1 and 5 min, respectively. This case demonstrates that cesarean delivery under general anesthesia can be performed safely in patients with pSS complicated by severe ITP through individualized anesthetic planning, perioperative platelet optimization, and multidisciplinary coordination.