Thrombocytopenia in Pregnancy

Excerpt

Thrombocytopenia, defined as a platelet count of under 150 x 10^9/L, is the second most common hematological abnormality in pregnancy. The International working group (IWG) adopted a lower threshold of platelets, 100 x 10^9/L, to define immune thrombocytopenia, which is observed in less than 1% of all pregnancies. Thrombocytopenia in pregnancy occurs either due to obstetric conditions (like gestational thrombocytopenia, pre-eclampsia/eclampsia) or secondary to systemic disorders (like thrombocytopenic thrombotic purpura, immune thrombocytopenia). For the present discussion, the approach to thrombocytopenia has its basis on the trimester in which the thrombocytopenia develops and the etiology of the thrombocytopenia. This division will help in understanding the workup and guiding management. Even though thrombocytopenia is a common abnormality in pregnancy, it seldom leads to life-threatening complications by itself. The management of thrombocytopenia focuses on the underlying cause. Platelet transfusion is usually not required to achieve a particular goal and is only for bleeding patients. Local hospital policies govern the goal of platelet counts and are quite variable between institutions. Nevertheless, a hematologist must be involved in the management of thrombocytopenia in pregnancy, especially if the platelet count drops below 70 x 10^9/L, or if a coexistent bleeding disorder is either encountered or suspected.