Thrombocytopenia in Preg Flashcards
Most common thrombocytopenia?
Gestational Thrombocytopenia
Most common causes
Occurs in 5-11% of pregnancy women
Normal platelet life and function
Platelet counts usually stay above 100K
Most often presents in third trimester, resolved 4 weeks postpartum
Etiology unclear
NO FETAL EFFECT KNOWN
DIAGNOSIS OF EXCLUSION
Platelets greater than what level to get an epidural?
70K
Platelets greater than what level for a cesarean delivery?
50k
When do you need to treat ITP?
- Symptoamtic bleeding
- PLT < 30k (even if asymptomatic)
- Need PLT higher for procedure (50K for CS, 70K for epidural)
What is treatment for ITP?
- Prednisone 0.5-2 mg/kg QD (peak response in 1-4 wk)
- If not effective, IVIG - 1 g/kg once
- If not effective, Splenectomy in second trimester
What are the fetal effects of ITP?
Fetal/neonatal thrombocytopenia can occur (IgG crosses placenta)
RARE to have fetal intracranial hemorrhage
Avoid FSE or Operative delivery unless clinically indicated
Check umbilical cord platelet count after delivery
Characteristics of gestational TCP?
- Onset can occur at any time, but generally in the third trimester
- Most cases PLT count stays above 75K
- Women are asympomatic with no hx of bleeding
- No Hx of TCP outside of pregnancy
- PLTS return to normal count 1-2 months after birth
- Incidence of fetal or neonatal TCP is low (< 2%)
Work up for low platelets?
- CBC (to exclude pancytopenia)
- Peripheral smear (rule out platelet clumping, may be a cause of pseudothromobytopenia)
- If first tri > typically ITP
- If PLT 100-150k, no hx of bleeding problems, and asympomatic = GTCP
- If < 100k then likely ITP, if < 50k most certainly IPT
- If third tri/acute onset > rule out Pre E, TTP, HUS, Acute fatty liver, DIC, and ITP
Differential diangosis for thrombocytopenia in pregnancy?
Gestational Thrombocytopenia
Immune thrombocytopenia
HELLP syndrome/ DIC
Acute Fatty Liver
TTP (Adamts13 mutation)
HUS
