Gestational thrombocytopenia

Gestational thrombocytopenia
SpecialtyObstetrics Hematology

Gestational (incidental) thrombocytopenia is a condition that commonly affects pregnant women. Thrombocytopenia is defined as the drop in platelet count from the normal range of 150,000–400,000/μL to a count lower than 150,000/μL.[1] There is still ongoing research to determine the reason for the lowering of platelet count in women with a normal pregnancy. Some researchers speculate the cause to be dependent on dilution, decreased production of platelets, or an increased turnover event.[2] Although women with normal pregnancy experience a low platelet count, women experiencing a continuous drop in platelet will be diagnosed with thrombocytopenia and women with levels greater than 70,000/μL will be diagnosed with gestational thrombocytopenia.[2]

Thrombocytopenia affects approximately 7–10% of pregnant women and of the 7–10%, within that population; approximately 70–80% have gestational thrombocytopenia [3]

Gestational thrombocytopenia is a disorder similar to immune thrombocytopenia (ITP) and is difficult to differentiate between the two disorders.[2] Therefore, a medical history is conducted to because a diagnostic test is unavailable.[2]

Signs and symptoms[edit]

Although there are no alarming symptoms related to gestational thrombocytopenia, an individual with thrombocytopenia might show the following symptoms[4] –

  • Nose bleeds
  • Gums bleeding
  • Blood in urine/stool
  • Easily bruised
  • Enlarged spleen
  • Jaundice
  • Continuous bleeding due to cuts
  • Rash-like spots (petechiae), mainly on the lower legs

Causes[edit]

It is evident that there is a decrease in platelet count during pregnancy; however, the cause of the decrease is unknown.[2] However researchers theorize that the decrease in platelet count is due to the decreased production of platelets and/or increased destruction of platelets.[4]

Mechanism[edit]

Generally, there is a decrease in platelet count in pregnant women and it will be due to many reasons.[1] The two main causes of thrombocytopenia are a decrease in the production of platelets in the bone marrow and an increase in the destruction of the platelets.[4] Platelets, along with other components of the blood, are produced in the spongy tissue found in the bone, known as bone marrow.[medical citation needed] Low platelet count maybe due to the decreased production of platelets in the bone marrow. A decreased production would be due to vitamin B12 deficiency, iron deficiency, aplastic anemia, viral infections, chemotherapy, alcohol consumption, leukemia, myelodysplasia, and cirrhosis.[medical citation needed] During pregnancy, the fetus’ waste products diffuse into the mother’s sinuses (blood stream), and cause the mother's spleen to become overactive and enlarged.[5] Normally, the spleen filters and removes the waste products and with the overload of unwanted substances in the bloodstream, the spleen will remove blood cells too quickly [5] or store the platelets.[4] In both cases, the overactive spleen would cause a decrease in the circulation of the platelets.[4]

Diagnosis[edit]

Gestational thrombocytopenia will become evident during the mid-second trimester through the third trimester of pregnancy and it is diagnosed based on exclusion.[2] For example, women with a history of immune thrombocytopenia or thrombocytopenia, prior to pregnancy, will not be diagnosed with gestational thrombocytopenia.[2]

Patients with low platelet counts, lower than 70,000/μL, will be difficult to diagnose because low platelet counts maybe due to gestational thrombocytopenia or immune thrombocytopenia.[6] In such cases, a treatment of immune thrombocytopenia therapy (corticosteroids, or intravenous immunoglobulin) will be instructed.[6] If there is an improvement in the platelet levels, the patient will be diagnosed with immune thrombocytopenia, and if not the patient will be diagnosed with severe gestational thrombocytopenia[2]

In order for the physician to determine the underlying cause of the gestational thrombocytopenia, the following tests are conducted:

Blood test[edit]

During routine prenatal checkups, the physician will conduct a complete blood count test to determine the components of blood. The complete blood count will provide further information about platelet levels.

Ultrasound[edit]

The physician may conduct an ultrasound around the spleen to determine if the spleen is enlarged.[medical citation needed]

Bone marrow aspiration or biopsy[edit]

The physician may conduct a bone marrow aspiration or bone marrow biopsy, if there is a decreased production of platelets in the bone marrow.[medical citation needed] A bone marrow aspiration and bone marrow biopsy may be conducted at the same time.

Prevention[edit]

There is no known information regarding the prevention of this disorder.[citation needed] There is no known information regarding the group of women who are likely to be diagnosed with this disorder.[citation needed]

Treatment[edit]

Women, diagnosed with gestational thrombocytopenia, will have their complete blood test conducted during each pre-natal visit and monitored by the doctor.[6] Having diagnosed gestational thrombocytopenia, women should continue their normal activities because the diagnosis does not change the management of pregnancy.[6] Also, the diagnosis of gestational thrombocytopenia poses no harm or risk to the mother or the fetus.[7] There are no diagnostic tests available for gestational thrombocytopenia; rather it is diagnosed based on exclusion.[6] Women who have a history of immune thrombocytopenia or thrombocytopenia prior to becoming pregnant would not be diagnosed with gestational thrombocytopenia[6]

Women who have platelet levels lower than 70,000 / μL, during pregnancy, maybe experiencing severe gestational thrombocytopenia or immune thrombocytopenia.[6] In such cases, if the treatment of immune thrombocytopenia therapy (corticosteroids, or intravenous immunoglobulin)[2] does not improve the platelet count, the patient will be diagnosed with severe gestational thrombocytopenia.[2] Severe gestational thrombocytopenia may pose a risk for complications with the use of epidural or general anesthesia during delivery.[6]

Prognosis[edit]

Those who have no previous history of thrombocytopenia, besides the occurrence in previous pregnancies (gestational thrombocytopenia), the platelet levels will go back to a normal range 1–2 months after the delivery.[6] Post delivery, approximately 1–3 months later, women with gestational thrombocytopenia should have a complete blood test conducted.[6] Lastly, gestational thrombocytopenia is a disorder that may reoccur in future pregnancies [3]

History[edit]

A history of this disorder has not yet been established.

References[edit]

  1. ^ a b Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy. Proc Obstet Gynecol. 2013;3(1): Article 6 [15 p.]. Available from: https://doi.org/10.17077/2154-4751.1193. Free full text article
  2. ^ a b c d e f g h i j Mccrae, Keith R. "Thrombocytopenia in Pregnancy." Platelets (2013): 909-28. Web
  3. ^ a b 2013 Clinical. Practice Guide on. Thrombocytopenia in Pregnancy. Presented by the American. Society of Hematology. Anita Rajasekhar, MD, MS
  4. ^ a b c d e "Thrombocytopenia (low platelet count) Symptoms - Mayo Clinic". www.mayoclinic.org. Retrieved 2015-11-30.
  5. ^ a b "Hypersplenism: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-12-01.
  6. ^ a b c d e f g h i j Gernsheimer, T., A. H. James, and R. Stasi. "How I Treat Thrombocytopenia in Pregnancy." Blood 121.1 (2012): 38-47. Web.
  7. ^ Myers, Bethan, and Edward Truelove. "Diagnosis And Management Of Thrombocytopenia In Pregnancy." Fetal and Maternal Medicine Review Fet. Matern. Med. Rev. 22.02 (2011): 144-67. Web.

External links[edit]

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