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Blood Res 2022; 57(S1):

Published online April 30, 2022

https://doi.org/10.5045/br.2022.2022068

© The Korean Society of Hematology

Diagnosis and management of thrombocytopenia in pregnancy

Young Hoon Park

Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

Correspondence to : Young Hoon Park, M.D.
Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea
E-mail: carrox2yh@gmail.com

Received: March 16, 2022; Revised: April 1, 2022; Accepted: April 12, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thrombocytopenia, defined as platelet count <150×109/L, is frequently observed by physicians during pregnancy, with an incidence of approximately 10% of all pregnancies. Most of the cases of thrombocytopenia in pregnancy are due to gestational thrombocytopenia, which does not confer an increased risk of maternal bleeding. However, because other causes can be associated with life-threatening events, such as severe bleeding, that can affect to maternal and fetal outcomes, differentiating other cause of thrombocytopenia, which includes preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, acute fatty liver of pregnancy, immune thrombocytopenia, hereditary thrombocytopenia, antiphospholipid syndrome, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome, is important. Understanding the mechanisms and recognition of symptoms and signs are important to decide an adequate line of investigation. In this review, the approach to diagnosis and the management of the thrombocytopenia commonly observed in pregnancy are presented.

Keywords Thrombocytopenia, Pregnancy, Management

Article

Review Article

Blood Res 2022; 57(S1): S79-S85

Published online April 30, 2022 https://doi.org/10.5045/br.2022.2022068

Copyright © The Korean Society of Hematology.

Diagnosis and management of thrombocytopenia in pregnancy

Young Hoon Park

Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

Correspondence to:Young Hoon Park, M.D.
Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea
E-mail: carrox2yh@gmail.com

Received: March 16, 2022; Revised: April 1, 2022; Accepted: April 12, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thrombocytopenia, defined as platelet count <150×109/L, is frequently observed by physicians during pregnancy, with an incidence of approximately 10% of all pregnancies. Most of the cases of thrombocytopenia in pregnancy are due to gestational thrombocytopenia, which does not confer an increased risk of maternal bleeding. However, because other causes can be associated with life-threatening events, such as severe bleeding, that can affect to maternal and fetal outcomes, differentiating other cause of thrombocytopenia, which includes preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, acute fatty liver of pregnancy, immune thrombocytopenia, hereditary thrombocytopenia, antiphospholipid syndrome, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome, is important. Understanding the mechanisms and recognition of symptoms and signs are important to decide an adequate line of investigation. In this review, the approach to diagnosis and the management of the thrombocytopenia commonly observed in pregnancy are presented.

Keywords: Thrombocytopenia, Pregnancy, Management

Fig 1.

Figure 1.Diagnostic algorithm for hereditary thrombocytopenias. Adapted from Noris and Pecci [22] Hereditary thrombocytopenias: a growing list of disorders. Hematology Am Soc Hematol Educ Program. 2017;2017:385-99.
Abbreviations: ANKRD26-RT, ANKRD26-related thrombocytopenia; CAMT, congenital amegakaryocytic thrombocytopenia; DIAPH1-RT, DIAPH1-related thrombocytopenia; ETV6-RT, ETV6-related thrombocytopenia; FPD/AML, familial platelet disorder with propensity to acute myelogenous leukemia; MYH9-RD, MYH9-related disease; NMMHC-IIA, nonmuscle myosin heavy chain-IIA; RUSAT, radioulnar synostosis with amegakaryocytic thrombocytopenia; SRC-RT, SRC-related thrombocytopenia.
Blood Research 2022; 57: S79-S85https://doi.org/10.5045/br.2022.2022068

Table 1 . Laboratory abnormalities by cause of thrombocytopenia..

GTITPHTTTPaHUSPECHELLPAFLPAPS
CBC
PLT (×109/L)≥75Any, variable20–130<10020–150>50 (<50 in <5%)50–100>50≥50
Hemoglobin---↓↓↓↓-/↓-/↓--
PBS-±Few large PLTs±Giant PLT or small PLTs ±WBC inclusionsSchistocytes +++Schistocytes +++±Schistocytes±Schistocytes-±Schistocytes
LDH---↑↑↑↑↑↑↑↑↑↑↑↑-
Creatinine----/↑↑↑↑-/↑-/↑-/↑
AST/ALT----/↑-/↑-↑↑↑↑↑↑-/↑
Bilirubin
Direct---↑↑↑↑-/↑↑↑↑↑-
Indirect---↑↑-
PT/aPTT------/↑↑↑-/↑
Urine protein-----/↑
Other features---ADAMTS13 ≤10%ADAMTS13 >10%--HypoglycemiaAntibody to cardiolipin and/or β2 glycoprotein and/or lupus anticoagulant

Adapted from Cines and Levine [1] Thrombocytopenia in pregnancy. Blood 2017;130:2271-7..

Abbreviations: AFLP, acute fatty liver of pregnancy; aHUS, atypical hemolytic uremic syndrome; ALT, alanine aminotransferase; APS, antiphospholipid syndrome; aPTT, activated partial thromboplastin time; AST, aspartate aminotransferase; CBC, complete blood count; GT, gestational thrombocytopenia; HELLP, hemolysis, elevated liver enzyme and low platelet count; HT, hereditary thrombocytopenia; ITP, immune thrombocytopenia; LDH, lactate dehydrogenase; PBS, peripheral blood smear; PEC, preeclampsia; PLT, platelet; PT, prothrombin time; TTP, thrombotic thrombocytopenic purpura; WBC, white blood cell..


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