Clinical relevance of gestational thrombocytopenia of <100,000/μl

Abstract

We identified 22 women with thrombocytopenia of < 100,000/microliters found incidentally during pregnancy and prospectively monitored their platelet count and clinical outcome for a minimum of 6 months postpartum. During the study period, four women became pregnant twice, accounting for a total of 26 pregnancies. The lowest platelet count during pregnancy was 65,600/microliters +/- 19,400 (mean +/- SD), and at delivery 84,500/microliters +/- 32,300 (P < 0.02). The thrombocytopenia was virtually asymptomatic in all patients during the pregnancy and delivery, whether vaginal or surgical. Neonatal platelet counts (n = 18) were normal (270,700/microliters +/- 69,900), and none of the newborns (n = 24) had a bleeding diathesis. Normalization of the platelet count (i.e., > 150,000/microliters) was documented in 18 patients within 1 month postpartum, in five within 3 months postpartum, and in two as late as 5 months after delivery. One woman did not recover from the thrombocytopenia and eventually developed other stigmata of an autoimmune disease. Long-term follow-up showed recurrence of thrombocytopenia in four patients: three in the context of a subsequent pregnancy and one who developed idiopathic thrombocytopenic purpura. Retrospective analysis of blood counts obtained from 12 previous pregnancies demonstrated thrombocytopenia of a similar degree to the index pregnancy. We conclude that gestational thrombocytopenia of < 100,000/microliters is clinically a benign phenomenon that can recur in subsequent pregnancies and is not accompanied by neonatal thrombocytopenia. In some cases, however, pregnancy-associated thrombocytopenia may be a manifestation of an autoimmune disease with its attendant implications for the neonate. Since the differential diagnosis between the two conditions may be difficult to establish when first encountered during pregnancy, a conservative approach emphasizing careful surveillance and guarded reassurance is justified as long as the platelet counts are > 50,000/microliters.

Clinical features of gestational thrombocytopenia difficult to differentiate from immune thrombocytopenia diagnosed during pregnancy

“…The sample size was small, and the platelet counts were not determined using a consistent protocol. However, there are only a few reports describing the clinical features of GT that are difficult to differentiate from ITP . Our study revealed that onset in the first trimester and a nadir count of less than 70 000/μL are not necessarily rare even in cases of GT, and that GT is more frequently observed in cases of twin pregnancy.…”

“…However, there are only a few reports describing the clinical features of GT that are difficult to differentiate from ITP. 4,14,17,18 Our study revealed that onset in the first trimester and a nadir count of less than 70 000/μL are not necessarily rare even in cases of GT, and that GT is more frequently observed in cases of twin pregnancy. Because of these findings, we consider our study to be of clinical significance.…”

“…On the contrary, there are also some reported cases of GT in which spontaneous recovery of the platelet count was not observed for a few months after delivery. [14][15][16] Thus, to differentiate between GT and ITP in cases of severe thrombocytopenia with platelet counts of less than 100 000/μL during pregnancy, long-term follow-up of fluctuations in platelet counts is necessary. This study has several limitations.…”

Thrombocytopenia during pregnancy in women with HIV infection receiving no treatment

“…[3] gTCP is usually mild (platelet count 100 -150 × 10 9 /L), and al though the minimum threshold has never been established, counts of ≤70 × 10 9 /L are uncommon. [5] Severe TCP (≤50 × 10 9 /L) is rare, occurring in ≤0.1% of pregnancies. [6] In these cases, pathological causes of increased destruction or utilisation of platelets such as preeclampsia/eclampsia, the HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count), and microangiopathies such as thrombotic thrombocytopenic purpura, (auto)immune thrombocytopenic purpura, haemolytic uraemic syndrome and haemolysis are likely.…”

Obstetric prognosis of the gestational thrombocytopenia

“…We performed PUBS in the 7 women with GT and an emergency cesarean section in 1 case was done due to the complication of PUBS-induced severe fetal bradycardia. [9] 1986 < 135,000 14 / 34 0 Nagey [15] 1986 < 150,000 2/ 14 0 Burrows [4] 1988 < 150,000 12 / 300 0 Kaplan [11] 1990 < 150,000 4/ 31 1 Matthews [12] 1990 < 150,000 3/ 40 0 Samuels [16] 1990 < 150,000 3/ 74 0 Copplestone [6] 1992 < 120,000 0/ 14 0 Jaschevatzky [17] 1994 < 100,000 0/ 19 0 Anteby [18] 1994 Anteby and Shalev [18] reported that maternal thrombocytopenia resolved spontaneously to more than 150,000 / mm 3 in eighteen patients within 1 month postpartum, in ve within 3 months postpartum, and in two as late as 5 months after delivery among 26 pregnancies with GT. They also showed recurrence of thrombocytopenia in four patients in the same study: three in the context of a subsequent pregnancy and in one patient who developed ITP.…”