Thrombocytopenia in pregnancy
- James N George, MD
James N George, MD
- Professor of Medicine
- University of Oklahoma Health Sciences Center
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Deputy Editors
- Jennifer S Tirnauer, MD
Jennifer S Tirnauer, MD
- Deputy Editor — Hematology
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Thrombocytopenia occurring during pregnancy is a common diagnostic and management problem and may have many causes (table 1) The most common of these, along with their manifestations, are shown in the table (table 2). Asymptomatic thrombocytopenia is observed near term in about 5 percent of normal pregnancies, and thrombocytopenia, sometimes severe, develops in about 15 percent of women with preeclampsia , which itself occurs in about 3 to 4 percent of pregnancies in the United States (table 3) . The diagnosis and management of thrombocytopenia in pregnancy will be discussed here . This discussion will focus on two issues:
●Thrombocytopenia discovered incidentally during a normal pregnancy and its distinction from immune thrombocytopenia (ITP)
●Thrombocytopenia associated with preeclampsia/eclampsia and the HELLP syndrome and their distinction from thrombotic thrombocytopenic purpura (TTP)
An overall approach to the patient with thrombocytopenia is discussed separately. (See "Approach to the adult with unexplained thrombocytopenia".)
Platelet counts are within the normal range of 150,000 to 450,000/microL in the vast majority of women during normal pregnancies, however they may be slightly lower, on average, than in healthy, non-pregnant women [4-6].
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- www.ouhsc.edu/platelets (Accessed on March 01, 2011).
- NORMAL PREGNANCY
- GESTATIONAL THROMBOCYTOPENIA
- Differential diagnosis
- Platelet count monitoring
- Course and prognosis
- IMMUNE THROMBOCYTOPENIA (ITP)
- Maternal management issues
- - Early pregnancy
- - Neuraxial anesthesia
- - Delivery and postpartum
- Fetal/neonatal management issues
- PREECLAMPSIA AND HELLP SYNDROME
- Definitions and prevalence
- Degree of thrombocytopenia
- Differential diagnosis
- - Use of dexamethasone for HELLP syndrome
- Incidence and timing
- Hereditary versus acquired syndromes
- Evaluation and diagnosis
- Recurrence in subsequent pregnancies
- HEPARIN-INDUCED THROMBOCYTOPENIA (HIT)
- ADDITIONAL INFORMATION
- SUMMARY AND RECOMMENDATIONS