Hematologic Disorders In Pregnancy

Question 1

What is the differential diagnosis (top 3) for thrombocytopenia in pregnancy?

Answer 1

(1) Gestational Thrombocytopenia
(2) ITP
(3) Pre-eclampsia w/HELLP

Question 2

What are the platelet target for vaginal delivery, c-section and neuraxial anasthesia in pregnant patients with ITP?

Answer 2

Vaginal Delivery > 30
C-Section > 50
Neuraxial Anesthesia > 80

Question 3

What are the platelet transfusion targets for a pregnant woman with HELLP/preeclampsia?

Answer 3

Platelets < 20: Transfuse All
C-Section: Transfuse if platelets < 50
Platelets > 50: Transfuse if actively hemorrhaging or if rapidly falling counts with other coagulopathy.

Question 4

How do you treat ITP during pregnancy?

Answer 4

Prednisone or IVIG

Do not give dexamethasone because it crosses the placenta. You will also need to get a paediatrics consult to rule out neonatal thrombocytopenia.

Question 5

What happens to VWF during pregnancy?

Answer 5

Levels of VWF go up in the 3rd trimester of pregnancy in all women, such that a women suspected to have VWD may have normal VWF antigen and restore it in cofactor in trimester 3 and will need repeat testing in the postpartum period.

Question 6

What are the 4 “T’s” of postpartum hemorrhage in pregnancy?

Answer 6

Tone - Uterine atony
Trauma - Lacerations in the birth canal
Tissue - Retained placenta
Thrombin - Coagulopathy (least common)