Thrombocytopenia in Pregnancy
        Main and The Obgyn Clinic of Hvidovre (danish)
        Cause
        • Spurious
        • Benign gestational (see below)
        • Neonatal alloimmune thrombocytopenia
        • Autoimmune (idiopathic thrombocytopenic purpura (ITP))
        • Drug related
        • Systemic lupus erythematosos (SLE) and antiphospholipid syndrome
        • HELLP syndrome
        • Disseminated intravascular coagulation (DIC)
        • Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura (HUS/TTP)
        • Bone-marrow suppression
        • Folate deficiency
        • Hypersplenism
        Gestational thrombocytopenia
        Up to 8% of pregnancies, typical >70,000 and two-thirds 130.000-150.000 asymptomatic, normalized after 8-12 weeks after delivery.
        Some suggest mild form for ITP (se below) No definite diagnostic tests distinguished from mild ITP, the mother should be monitored closely and epidural considered if platelets is above 50,000-80.000.

        ITP - Idiopathic (autoimmune) Thrombocytopenic (purpura)
        • Autoantibodies of IgG types. Measurements of antibodies are useless.
        • Often known before pregnancy with history of treatment with autoimmune disease treated with steroids, gamma globulin and splenectomy. Fetal neonatal asymptomatic thrombocytopenica in 10-30% of cases, lowest day 2-4.
        • Very little risk for serous fetal thrombocytopenia but splenectomy and platelets < 50.000 during pregnancy in mothers increase the risk. Cord blood not indicated.
        • Cesarean section only on obstetrics indications.

        Management
          Platelets > 50
          Control every 2-4 weeks
          No epidural if < 80

          Platelets < 50

          Medical treatment with Prenisone 1-2 mg/kilo.
          Response after 3-7 days
          max. within 2-3 weeks.
          Intravenous immune Globulin (IVIG) response after 72 hours.
          Return to pre-treatment levels after 30 days.
          If < 20 thrombocytes, transfusion first (6-10 U). Splenectomy if failed steroid and immuno-globulin and platelets < 10.000

        References:
        (1) ACOG Practice Bulletin Number 6, September 1999.

        (2) Burrows RF. Platelet disorders in pregnancy. Current Opinion in Obstetrics and Gynecology 2001, 13:115-119.

        (3) Gernsheimer T, McCrae KR. Immune thrombocytopenic purpura in pregnancy. Curr Opin Hematol, 2007 Sep;14(5): 574-80..

        (3) Guideline. 1996 Blackwell Science Ltd. British Journal of Hematology 95: 21-26.

        (4) Nielson-Piercy C. Handbook of Obstetric Medicine published in the United Kingdom in 2002 by Martin Dunitz Ltd.

        Top Home Table of Contents

        Feel free to mail me or the webmaster Dr Lars Krag Moeller if you have suggestions or corrections that you believe could improve the manual. (niels.secher@hvh.regionh.dk)
        Terms of use for the site