Thrombocytopenia during pregnancy

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Thrombocytopenia during pregnancy

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  • Thrombocytopenia During pregnancy Prof Aboubakr Elnashar Benha university Hospital, Egypt Aboubakr Elnashar
  • Causes 1. Spurious result (reduced platelets on automated Coulter counter {platelet clumping or misreading of large immature platelets as red cells} 2. Gestational thrombocytopenia 3. Immune thrombocytopenic purpura (ITP) 4. Pre-eclampsia and Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome 5. Disseminated intravascular coagulation (DIC) Aboubakr Elnashar
  • 6. Haemolytic uraemic syndrome (HUS) /thrombotic thrombocytopenic purpura (TTP) 7. Sepsis 8. Human immunodeficiency virus (HIV), drugs and infections (e.g. malaria) 9. Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) 10. Bone marrow suppression. Aboubakr Elnashar
  • Incidence 5-10%: of pregnant women Gestational' thrombocytopenia:75% Chronic ITP: 1-2/10,000 pregnancies. usually affects young Women female to male ratio = 3:1 Aboubakr Elnashar
  • AIloimmune thrombocytopenia fetal disorder {fetomaternal incompatibility for platelet antigens (similar to Rhesus haemolytic disease of the newborn)} No maternal symptoms and the mother is not thrombocytopenic. The condition develops in utero, affects all children including the firstborn, but is usually (except in the case of Subsequent siblings) diagnosed after birth. Incidence: 1 in 2000 causes 10% of all cases of neonatal thrombocytopenia. Aboubakr Elnashar
  • Clinical features Gestational thrombocytopenia: Benign condition platelet count 50 x 109/L Spontaneous haemorrhage without surgery: unlikely with counts >20 x 109/L. skin bruising or gum bleeding severe haemorrhage: rare. Aboubakr Elnashar
  • Pathogenesis Gestational thrombocytopenia Normal pregnancy: Platelet count fall progressively 5% to 10%: thrombocytopenic levels (50-150 x 109/L) by term. ITP Autoantibodies against platelet surface antigens: peripheral platelet destruction by the reticuloendothelial system, particularly the spleen. Aboubakr Elnashar
  • Diagnosis ITP By exclusion: other causes (infection and PET) Bone marrow: normal or megakaryocytic not necessary in pregnancy in cases of isolated thrombocytopenia unless it is severe (platelet count 50 x 109/L Spontaneous mucous membrane bleeding: not a risk with platelet counts >20 x 109/L. Aboubakr Elnashar
  • Antiplatelet IgG can cross the placenta: fetal thrombocytopenia. Prediction of the fetal platelet count from maternal platelet count antibody level or splenectomy status: not possible Fetal platelet counts 50 x 109/L. The risk of serious thrombocytopenia and haemorrhage in the neonate from transplacental passage of antiplatelet IgG is low. CS is only required for obstetric indications and epidural and spinal anaesthesiajanalgesia are safe with stable counts >75 to 80 x 109/L. Treatment, if required, should be with corticosteroids or IVIg). Aboubakr Elnashar
  • History and Physical Normal Repeat platlet count normal - Assume lab error - No further workup 1st T platlet count low Assume ITP Counsel: risks of neonatal thrombocytopenia Inform anesthesia and pediatric staff Ensure no spontaneous bleeding Ensure platelets >50K at delivery 1st T platlet count normal Assume gestational thrombocytopenia: no further work up Abnormal Aboubakr Elnashar
  • Abnormal History of medications -Alternative medication - Counsel maternal an fetal risk Evidence of systemic disease Management depend on type of illness e.g. self limiting viral illness or ch rheumatologic dis Elevated BP with normal BP in 1st T Assume hypertensive disorder of pregnancy Management depend on gest age and s and s of maternal and f disease Aboubakr Elnashar
  • Thanks Aboubakr Elnashar