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Thrombocytopenia in pregnancy

INTRODUCTION

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 [1], which itself occurs in about 3 to 4 percent of pregnancies in the United States (table 3) [2]. The diagnosis and management of thrombocytopenia in pregnancy will be discussed here [3]. 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-hemolytic uremic syndrome (TTP-HUS)

An overall approach to the patient with thrombocytopenia is discussed separately. (See "Approach to the adult patient with thrombocytopenia" and "Evaluation and management of thrombocytopenia by primary care physicians".)

NORMAL PREGNANCY

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, nonpregnant women [4-6].

  • Most reports of serial platelet counts during normal pregnancies have noted no change in the platelet count as pregnancy progresses [7-12].
  • Some studies have documented a slight but statistically significant decrease of the mean platelet count, still within the normal range, as pregnancy progresses, which may reflect the influence of the few women who develop mild gestational thrombocytopenia [13-15]. (See "Hematologic changes in pregnancy", section on 'Platelet count'.)
  • Platelet counts may be slightly lower in women with twin compared with singleton pregnancies, perhaps related to a greater increase of thrombin generation [16].

                   

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Literature review current through: May 2013. | This topic last updated: Dec 5, 2012.
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