Thrombocytopaenia in Pregnancy: When to Intervene

Abstract

thrombocytopaenia in pregnancy is common and most likely represents a benign process. Gestational thrombocytopaenia is the presence of a mild thrombocytopaenia in a healthy woman near term. It requires no intervention and poses no risk to mother or baby. Immune thrombocytopaenic purpura (ITP) is common in pregnancy and may lead to maternal bleeding complications during delivery and, rarely, to fetal intracranial haemorrhage. Maternal treatment with glucocorticoids near term is recommended for severely thrombocytopaenic mothers. Neither fetal blood sampling nor Caesarean section is recommended for patients with ITP in pregnancy. Thrombotic thrombocytopaenic purpura (TTP), haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and haemolytic uraemic syndrome (HUS) are all thrombotic micro-angiopathies with the same underlying pathophysiological process. These disease processes may result in micro-angiopathic haemolytic anaemia, a consumptive thrombocytopaenia and evidence of widespread organ damage. The organ that is preferentially affected determines the disease process that occurs. Prompt diagnosis and treatment in these disease processes are essential. This article describes diagnosis and treatment of the above causes of thrombocytopaenia in pregnancy.