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Thrombocytopenia In Pregnancy

Get the facts on Thrombocytopenia In Pregnancy treatment, diagnosis, staging, causes, types, symptoms. Information and current news about clinical trials and trial-related data, Thrombocytopenia In Pregnancy prevention, screening, research, statistics and other Thrombocytopenia In Pregnancy related topics. We answer all your qestions about Thrombocytopenia In Pregnancy.

Question: Low blood platelet counts "thrombocytopenia" in pregnancy? I'm currently 13 wks pregnant. My doctor told me that my platelet counts have been falling since week 6, when they were already low. (116, now 78). I guess normal is >150, and severe thrombocytopenia is <50. I've been referred to a hematologist for further guidance, and my appointment is in two weeks. While I'm waiting, I was wondering: has anyone else ever had this, and what happened with them and their baby?

Answer: I found this for you...: The diagnosis and management of thrombocytopenia during pregancy presents difficult diagnostic and management problems. The diagnostic distinction among the potential etiologies for thrombocytopenia is often impossible, yet the diagnosis has major importance for management. Furthermore, management involves not only the care of the mother, but the anticipation of risk for thrombocytopenia in the infant. The following are the major etiologies for thrombocytopenia during pregnancy: Gestational Thrombocytopenia. In many women, mild thrombocytopenia occurs toward the end of pregnancy, and the platelet count returns to normal within days after delivery. The etiology for this phenomenon is unknown. This is the most common cause of thrombocytopenia during pregnancy, occurring in approximately 5% of women at term. Gestational thrombocytopenia is characterized by: (1) asymptomatic, mild thrombocytopenia, (2) with no past history of thrombocytopenia (except possibly during previous pregnancy, (3) that occurs during late gestation, (4) that is not associated with fetal thrombocytopenia, and (5) that resolves spontaneously after delivery. Platelet counts are typically over 70,000, with about two-thirds being between 130,000 and 150,000 (just below the lower limit of normal). Idiopathic thrombocytopenic purpura (ITP), cannot be distinguished from gestational thrombocytopenia with certainty because the diagnosis of both conditions is based upon the observation of thrombocytopenia with no other apparent cause. Although ITP may compose a higher percentage of cases when the platelet count is less than 70,000, or when thrombocytopenia is discovered earlier in pregnancy, gestational thrombocytopenia may still be the appropriate diagnosis if the thrombocytopenia resolves spontaneously after delivery. However, severe, refractory thrombocytopenia, presumably due to ITP, may also remit after delivery. The differential diagnosis between ITP and gestational thrombocytopenia is generally of little clinical importance with regard to the mother, because cases in which the diagnosis is unclear involve mild thrombocytopenia that does not threaten maternal health. The differential diagnosis is clinically important with regard to the fetus, because ITP with even mild thrombocytopenia may cause thrombocytopenia in the fetus, whereas gestational thrombocytopenia does not. Current tests for identifying anti-platelet antibodies do not help in the differential diagnosis. Idiopathic Thrombocytopenic Purpura (ITP). As described above, thrombocytopenia first discovered during pregnancy may be either ITP or gestational thrombocytopenia. The most important diagnostic step is to search the patient's record for evidence of thrombocytopenia when she was not pregnant. If no prior platelet counts are available, then the distinction rests upon the severity of thrombocytopenia and the time of its occurrence during pregnancy. More severe thrombocytopenia occurring earlier during pregnancy is more likely to be ITP. Management of the mother with ITP during pregnancy is essentially the same as in a non-pregnant patient, only the management is more conservative. Splenectomy hopefully is deferred until after delivery, and cytotoxic agents are avoided. The major focus of concern is on the risk for neonatal thrombocytopenia. In contrast to fetal alloimmune thrombocytopenia, which may be severe and cause intrauterine fetal hemorrhage, intrauterine fetal hemorrhage has not been reported in ITP. The main concern is for trauma at birth and its risk of provoking cerebral hemorrhage in the newborn infant. This serious complication is rare. Among infants born to women with ITP, 10% have platelet counts less than 50,000. Only 4% have counts less than 20,000 and are therefore at risk for hemorrhage at birth. Although it seems reasonable that cesarean section delivery is safer for the infant than vaginal delivery, there are no data to support this hypothesis. Current obstetrical recommendations are to proceed with routine vaginal delivery, reserving cesarean section for obstetrical indications. It is important to recognize that intracerebral hemorrhage may occur following birth, as the platelet count may fall further during the first week. Preeclamsia. About 5 to 10% of all pregnant women have preeclampsia, defined as hypertension and proteinuria beginning during the second half of gestation. From a hematologic standpoint, preeclampsia is the second most common cause of thrombocytopenia during pregnancy, since about 15% of patients with preeclampsia develop thrombocytopenia. It is managed by obstetrical care, with delivery resulting in predictable resolution. The difficulty is to distinguish preeclampsia from thrombotic thrombocytopenic purpura / hemolytic-uremic syndrome (TTP-HUS). Thr

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