Pregnancy related complications, such as preeclampsia, may also cause thrombocytopenia. Thrombocytopenia, defined as a platelet count of less than 150 x 109l, is common and occurs in 712% of pregnancies. Jan, 2017 thrombocytopenia 612% of pregnancies in third trimester second most common hematologic disorder in pregnancy important to determine the etiology to optimize clinical outcome maternal and neonatal implications. Symptoms of thrombocytopenia many women have no symptoms, but are found to have a low platelet count during their routine pregnancy check ups. The adult patient with thrombocytopenia thank you for choosing us for your health care needs. In some cases, the thrombocytopenia is also immunemediated. Acog does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to. Hypertensive disorders of pregnancy preeclampsia with and without severe features preeclampsia is a disorder of pregnancy associated with newonset hypertension, which occurs most often after 20 weeks of gestation and frequently near term. Acog practice bulletin on thyroid disease in pregnancy. Platelet counts during pregnancy a large analysis of normal and complicated pregnancies showed that platelet counts normally fall during pregnancy. Hypertensive disorders of pregnancy american family. The implications of thrombocytopenia in pregnancy vary with the etiology of the thrombocytopenia. Thrombocytopenia is a low blood count of platelets.
During pregnancy, thrombocytopenia was associated with pregnancy induced hypertension in 25. Hypertensive disorders of pregnancy lawrence leeman, md, mph, university of new mexico school of medicine, albuquerque, new mexico lee t. May 15, 2002 the committee on practice bulletinsobstetrics of the american college of obstetricians and gynecologists acog has developed a practice guideline on thyroid disease in pregnancy. Thrombocytopenia affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy. For individuals with a prior history of itp, the platelet count may decline further during pregnancy and improve after delivery 20. For many of the causes, there are no diagnostic laboratory tests. Aug 24, 2016 healthdaythrombocytopenia is common in pregnancy and can have causes that are serious medical disorders, with potential for maternal and fetal morbidity, according to a practice bulletin. Evaluation and management of thrombocytopenia during pregnancy and postpartum may be challenging.
Oct 14, 2000 conversely a cause for thrombocytopenia must be diligently sought when a low platelet count is detected in a woman with a normal pregnancy. Pdf diagnosis and management of thrombocytopenia in pregnancy. Thrombocytopenia with infection is usually caused by bone marrow suppression. While acog makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. If you continue browsing the site, you agree to the use of cookies on this website. The normal serum level of platelets in pregnancy is 150400 109l. Hypertensive disorders affect up to 10% of pregnancies in the united states. This article focuses on defining what those etiologies are and assessing risk and therapy for each. Acog practice bulletin thrombocytopenia in pregnancy 1999.
Postpartum plasma exchange for atypical preeclampsiaeclampsia as hellp hemolysis, elevated liver enzymes, and low platelets syndrome. View the article pdf and any associated supplements and figures for a period of. The laboratory range of platelet counts in pregnant women varies by trimester, with a gradual decrease as pregnancy progresses 4. Previous pregnancy affected by natp or previous baby affected severity, ich present or not fetal death due to intracranial hemorrhage neonatal thrombocytopenia of undetermined etiology all cases of neonatal thrombocytopenia thrombocytopenia are a decrease in the production of platelets in the bone marrow and an increase in the destruction of the platelets. Evaluation and management of thrombocytopenia during pregnancy and postpartum may be challenging because there are many potential causes, some directly related to the pregnancy and some unrelated. Although often accompanied by newonset proteinuria, hypertension and other signs or symptoms of. Gestational thrombocytopenia will become evident during the midsecond trimester through the third trimester of pregnancy and it is diagnosed based on exclusion.
This disorder usually develops in the late second or third trimester and generally affects women with no prior history of. Acog addresses thrombocytopenia in pregnancy 24 august 2016 healthdaythrombocytopenia is common in pregnancy and can have causes that are serious medical disorders, with potential for. Thrombocytopenia in pregnancy is a common reason for hematology consultation. Thrombocytopenia, defined as a platelet count of less than 150. Thrombocytopenia is caused by increased platelet destruction or decreased platelet production. Thrombocytopenia american academy of family physicians. In 2016, the american college of obstetricians and gynecologists acog published a practice bulletin on thrombocytopenia in pregnant. Pdf thrombocytopenia occurs commonly during pregnancy, and may result from diverse. Recommended articles cannot be displayed at this time.
Thrombocytopenia is a common finding in normal pregnancy. In the past, these patients would go undetected and be spared unnecessary testing, procedures, or medications. Some causes of thrombocytopenia are serious medical disorders that have the potential for maternal and fetal morbidity. Acog practice bulletin thrombocytopenia in pregnancy. Gestational thrombocytopenia incidental thrombocytopenia of pregnancy box2shows the typical characteristics of this disorder,which is the most common cause of thrombocytopenia in pregnancy,occurring in approximately 75% of cases of thrombocytopenia and 8% of all pregnancies. Maternity guidelines thrombocytopenia in pregnancy gl927 october 2017 the section below describes optimum management based on the different diagnoses of thrombocytopenia. Thrombocytopenia in pregnancy presents three major clinical challenges, including the need to. This practice bulletin is a targeted revision to reflect limited changes to information about new estimates for thrombocytopenia in pregnancy and the risk of recurrence of fetalneonatal alloimmune thrombocytopenia in subsequent pregnancies, and to provide new information on the level of thrombocytopenia that permits regional anesthesia. Thus, gestational thrombocytopenia has been imprecisely defined, as george points out. There are many potential causes of pregnancy associated thrombocytopenia.
It is a benign condition usually found incidentally later in pregnancy and there is no bleeding risk to mother or fetus. How i treat thrombocytopenia in pregnancy blood american. Maternal thrombocytopenia in pregnancy 2 thrombocytopenia table 1. In pregnancy, most cases are due to increased platelet destruction, which can be caused by an immunologic destruction, abnormal platelet activation, or platelet consumption that is a result of excessive bleeding or exposure to abnormal vessels. The severity of thrombocytopenia is variable and may change during the pregnancy, although for many patients the platelet count remains stable. Pdf thrombocytopenia is a common finding in pregnancy, occurring in. Thrombocytopenia in pregnancy amy sullivan, md maternalfetal medicine january, 2017. Aug 11, 2014 acog practice bulletin thrombocytopenia in pregnancy.
Review thrombocytopenia in pregnancy rcog elearning. The main concern is the possible thrombocytopenia that anagrelide could cause to the fetus while passing the placenta. Jan 03, 20 thrombocytopenia, defined as a platelet count 26 000 women suggest that its prevalence at the end of pregnancy is between 6. This information is to help answer some of your questions and to give you instructions to follow. Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to pregnancy. Although its pathogenesis is uncertain, gestational thrombocytopenia may be a result of various processes, including hemodilution and enhanced clearance 8. Dec 04, 2010 thrombocytopenia affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy. It is a benign condition usually found incidentally later in. Aug 04, 2014 thrombocytopenia during pregnancy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. For example, women with a history of immune thrombocytopenia or thrombocytopenia, prior to pregnancy, will not be diagnosed with gestational thrombocytopenia. American college of obstetricians and gynecologists committee on practice bulletinsobstetrics. Thrombocytopenia 612% of pregnancies in third trimester second most common hematologic disorder in. Guideline for the management of thrombocytopenia in pregnancy.
Thrombocytopenia in pregnancy hematology american society. When a specific cause cannot be identified, the diagnosis by exclusion becomes gestational thrombocytopenia. Most cases are mild, with evidence of widespread petechiae and other skin lesions. If you have any other questions, please ask your doctor or nurse. Patients with essential thrombocytosis during pregnancy. Sep 30, 2016 thrombocytopenia, or a low blood platelet count, is encountered in 78% of all pregnancies. Gestational thrombocytopenia definition of gestational.
Moreover, most pregnant women with itp may have a history of thrombocytopenia prior to pregnancy or may present with other immunemediated diseases. Healthday thrombocytopenia is common in pregnancy and can have causes that are serious medical disorders, with potential for maternal and fetal morbidity, according to. A mild thrombocytopenia is relatively frequent during pregnancy and has generally no. Normal pregnancy 150,000 450,000 remains stable throughout pregnancy slight decrease in some patients remains within normal limits. Acog addresses thrombocytopenia in pregnancy 24 august 2016 healthday thrombocytopenia is common in pregnancy and can have causes that are serious medical disorders, with potential for. Reduction of serum platelet counts is arbitrarily considered mild if the count is 100, moderate at. Women are more commonly diagnosed with platelet disorders during pregnancy since screening is done as part of the initial clinic evaluation with automated blood counts.
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