Contents

Search

thrombocytopenia of pregnancy (gestational thrombocytopenia)

Etiology: - incidental thrombocytopenia of pregnancy (gestational thrombocytopenia) most common - thrombotic microangiopathy of pregnancy (see Differential diagnosis below) Epidemiology: - 10% of women with uncomplicated pregnancies [5] Pathology: - platelet counts of 100,000-150,000/uL are typically caused by gestational thrombocytopenia, a normal physiologic process involving expanded intravascular volume & splenic as well as placental sequestration of platelets - platelet counts < 100,000/uL may be due to pathology such as ITP, preeclampsia, or HELLP syndrome Clinical manifestations: - presentation during 2nd & 3rd trimester Laboratory: - defined as platelet count < 150,000/uL at delivery [5] - complete blood count - thrombocytopenia, platelet count > 70,000/uL - platelet count < 50,000/uL (< 70,000/uL [1]) suggests ITP - peripheral blood smear: no shistocytes [1] Differential diagnosis: - platelet counts < 100,000/uL - immune thrombocytopenic purpura (ITP) - platelet count < 50,000/uL (< 70,000/uL) [1] - 1st trimester - prior history of thrombocytopenia [1] - thrombotic microangiopathy of pregnancy - preeclampsia - hypertension, proteinuria, edema, > 20 weeks gestation - HELLP syndrome: - hemolysis, abnormal liver function tests, > 20 weeks gestation - thrombotic thrombocytopenic purpura/hemolytic uremic syndrome - > 20 weeks gestation, not affected by termination of pregnancy [1] - acute fatty liver of pregnancy - hypoglycemia, coagulopathy at > 20 weeks of gestation - disseminated intravascular coagulation (DIC) Management: - no treatment is required for platelet counts > 50,000/uL (> 100,000/uL [1]) - for platelet counts < 50,000/uL see ITP, HELLP syndrome - goal of pregnant patients with ITP is a platelet count > 30,000-40,000 until the end of the 3rd trimester when a platelet count > 50,000/uL is needed for a safe delivery [1] - platelet count > 80,000/uL if spinal anesthesia anticipated [1] - treat with immune globulin or glucocorticoids [1] - immediate delivery of fetus with thrombotic microangiopathy of pregnancy [1]

General

pregnancy disorder; obstetric disorder; pregnancy complication thrombocytopenia

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2022. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Schwartz KA. Gestational thrombocytopenia and immune thrombocytopenias in pregnancy. Hematol Oncol Clin North Am. 2000 Oct;14(5):1101-16. PMID: 11005036
  3. Bockenstedt PL Thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2011 Apr;25(2):293-310 PMID: 21444031
  4. Myers B Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol. 2012 Jul;158(1):3-15. PMID: 22551110
  5. Reese JA, Peck JD, Deschamps DR et al. Platelet counts during pregnancy. N Engl J Med 2018 Jul 5; 379:32 PMID: 2997275 https://www.nejm.org/doi/10.1056/NEJMoa1802897
  6. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013 Jan 3;121(1):38-47. Review. PMID: 23149846 Free Article