Contents
Blood platelet count < 150,000/ìL during pregnancy.
- #2 M/C hematological abnormality in pregnancyy (after anaemia)
Aetiology
Obstetric conditions:
Common causes
- Gestational thrombocytopenia (GT) (M/C cause, 65-80%): Benign condition with moderate thrombocytopenia with no bleeding risk to mother or fetus
- Immune (idiopathic) thrombocytopenic purpura (#2 M/C): Autoimmune disorder characterized by anti-platelet glycoprotein antibodies that stimulate the platelet destruction in spleen
- Hypertensive disorder in pregnancy (PIH) (#3 M/C):
- Pre-eclampsia (PEC)
- Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome
- Acute fatty liver of pregnancy (AFLP)
Secondary to systemic disorders:
Uncommon
- TMA not specific to pregnancy:
- Thrombotic thrombocytopenic purpura (TTP)
- Atypical hemolytic-uremic syndrome (HUS)
- Disseminated intravascular coagulation (DIC)
- Other syndromes:
- Bone marrow failure syndromes
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Drug-induced thrombocytopenia
- Type IIB von Willebrand disease (VWD)
- Heparin-induced thrombocytopenia (HIT)
Clinical features
Gestational thrombocytopenia:
Patients with gestational thrombocytopenia are often healthy, asymptomatic women who are found to have low platelets on lab investigations.
- Mucocutaneous bleeding
- Severe coagulopathies: joint bleed or severe bleeding
Physical examination:
- Hepatomegaly and/or splenomegaly (cirrhosis, lymphoproliferative disorders, etc.)
- Skeletal deformities (like absent radius, humeral abnormality and sometimes phocomelia seen in thrombocytopenia absent radii syndrome)
- Skin exam (like petechiae or purpura seen commonly with ITP, or, eczema seen in Wiskott-Aldrich Syndrome)
Diagnosis
Gestational thrombocytopenia (GT):
Characterized by:
- Asymptomatic, mild thrombocytopenia (>70 000/μL)
- No past history of thrombocytopenia
- Occurrence during late gestation
- Not associated with fetal thrombocytopenia
- Resolves spontaneously after delivery
Management
In pregnancy, thrombocytopenia usually does not lead to an increased risk of bleeding. Even in patients with ITP, where thrombocytopenia is often quite severe, the risk of bleeding remains low.
Treatment is initiated for bleeding when the platelet count falls below 20 × 109/L to 30 × 109/L, and for procedures and delivery.The obstetric indication decides the mode of delivery.
