What to Expect when Diagnosed with Thrombocytopenia during Pregnancy

collecting bloodHaving an issue during pregnancy can be scary. You’ll wonder what the ramifications are for the baby and for yourself.

However, there are certain issues that are known to occur during pregnancy, and knowing about them can make getting through them a bit easier for yourself and your family to handle.

Thrombocytopenia is one of those issues. While it’s not common at all, it is a well-known problem. It’s defined as a low platelet count, meaning less than 150 x 109/L.

While thrombocytopenia affects anywhere from 7 to 10 percent of women, anemia (levels lower than 100 x 109/L) occurs in about one percent of women.[1]

One thing that’s important to note is that as you get further along in your pregnancy, you platelet counts naturally decrease, however it normally stays within an acceptable range, however for those that it does not, it does need to be monitored.

When there is another comorbidity associated with thrombocytopenia it can have serious effects on the mother and the child.[2]

Why Are Platelets Important

Platelets are extremely important in the maintenance of the body, especially after an injury. What they do is form clots to prevent bleeding.

After an injury, there is a signal sent out and the platelets are the first responders that clot in order to repair the damage.[3]

You can imagine how this would be important during pregnancy and labor. When you go into labor you naturally lose blood, things tearing, babies coming out, placenta being pushed out as well, etc.

There are a lot of chances for things to go wrong if your blood isn’t clotting, therefore having low platelet count, meaning below the levels that are acceptable, can be a major medical issue.

In order to deliver vaginally, they say that guidelines are platelets higher than 30.000/iL, and in order to get an epidural, it’s considered 75.000-80.000/iL.[4]

Other Conditions that Can Cause Thrombocytopenia

As stated earlier, many times when someone experiences this medical issue during pregnancy, there is an underlying condition that is causing the issue in the first place.

Some of the additional conditions could be different medicines (think blood thinners among others), cancer, kidney disease, infections, and a compromised immune system.[5]

If you are pregnant and they determine that you have any one of these issues, it’s something you’ll want to have monitored during and then after your pregnancy.

Clinical Assessment

When diagnosing a woman with thrombocytopenia they are going to look at a few different things.

When doing an assessment they will be looking at any previous or current bleeding issues, family history, alcohol and substance abuse history, and any transfusion history and how the previous (if any) pregnancy progressed.[6]

When they are also assessing you they will look at any current symptoms that might suggest that you are experiencing this issue. Some of the issues that they are looking for would be petechial, ecchymoses, and gum and nose bleeding.

While these are the more common symptoms, rare symptoms could include hematuria, gastrointestinal bleeding, and intracranial bleeding.[7]

Once they have determined what they are looking at, run blood work, etc. they are going to consider treatment if necessary and also considerations during labor and delivery.

Treatment

Generally, the altering of the management of the pregnancy is not necessary. Patients will receive blood work every 2-4 weeks and if the counts are less than 80 x 109/L after the 34th week of pregnancy they get monitored on a weekly basis.[8]

Generally, they are also given prednisone about 10 days prior to the estimated due date. They do treatment late in pregnancy generally because they want to prevent hemorrhaging during delivery, which could be a serious issue. [9]

That’s essentially the basis of the treatment that everything is held off until close to the date of delivery. When prednisone is given there can be additional issues that can occur such as increased weight gain, hyperglycemia, worsen hypertension and can lead to adverse reactions[10].

However, when the pros outweigh the cons and the potential for issues during delivery are apparent, they would rather start treatment at the end.

Once the pregnancy is over, the woman will be tested a few weeks later to determine if the low platelets were spontaneous during pregnancy or there is something else that is essentially going on in the body.

They will also test the newborn once they make their arrival and they will ensure that there are no issues with them either.

However, many reviews have shown that the newborns born to mothers with thrombocytopenia were fine and had no issues.

Considerations

Once it’s determined that you have it and treatments have started, you can generally go on to have a healthy and normal delivery (whatever that looks like for you), and hopefully, that means that the baby will be healthy too.

While the situation may be scary, when monitored and treated properly with the right prenatal and postnatal care, then your body can handle it well with the proper medications.

Thrombocytopenia might be a scary word and a scary journey, but managed right it will mean a safe delivery for you and your little one.

Do however ensure that when you go to the doctor if you noticed any of the symptoms described above, you have a conversation about it.

References

  1. Jennifer Donnelly via Clinical Advisor. Thrombocytopenia in Pregnancy. [link]
  2. See above #1
  3. University of Rochester Medical Center. What are Platelets? [link]
  4. NCBI. Thrombocytopenia in Pregnancy. [link]
  5. See above #3
  6. EMedicine. Overview, Definition and Clinical Manifestations, Etiologic Classification. [link]
  7. See above #6
  8. Blood Journal. How I Treat Thrombocytopenia in Pregnancy. [link]
  9. See above #8
  10. See above #8
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