Low Platelets (Thrombocytopenia) In Pregnancy: Causes And Treatment

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Thrombocytopenia in pregnancy is characterized by low platelets in pregnancy. Platelets are called thrombocytes, and hence the condition is called thrombocytopenia. A normal blood platelet count in healthy individuals ranges from 150,000 to 450,000 per microliter of blood. When the count falls below 150,000 platelets per microliter, it results in thrombocytopenia.

Thrombocytopenia is a common blood disorder during pregnancy. Although a slight decrease in platelet count is usually not concerning, a drastic fall may indicate a serious pregnancy complication (1).

Read on to learn the causes, symptoms, complications, treatment, and more on thrombocytopenia in pregnancy.

Occurrence Of Thrombocytopenia During Pregnancy

During normal pregnancy, there is a physiological drop in platelet counts due to changes in blood composition in pregnancy. Although usually mild and benign, thrombocytopenia is the second most common blood disorder in pregnancy, the first being anemia (1). The condition affects about 6-15% of pregnant women and is mostly seen in later trimesters or towards the end of pregnancy (2).

Classification Of Thrombocytopenia

Thrombocytopenia may be classified into three types based on the number of platelets per microliter of blood (3).

  • Mild: 100,000 to 150,000 platelets per microliter of blood
  • Moderate: 50,000 to 100,000 platelets per microliter of blood
  • Severe: Less than 50,000 platelets per microliter of blood

The platelet count usually drops during pregnancy for various reasons. However, in women who have platelet counts below moderate (around 100,000 per microliter of blood), other underlying health conditions and non-pregnancy-related etiologies must be evaluated.

Causes Of Low Platelets In Pregnancy

Some of the common causes of thrombocytopenia in pregnancy are (1):

  1. Gestational thrombocytopenia (GT): This is a benign condition in which platelet levels drop to moderate range and accounts for 70-80% of the cases of thrombocytopenia in pregnancy. The reason for a decrease in platelet count is unknown. GT usually develops in the third trimester and is mostly asymptomatic, resolving spontaneously.
  1. Hypertensive disorders: Thrombocytopenia associated with hypertensive disorders, such as preeclampsia, eclampsia, and HELLP syndrome, is the second leading cause of thrombocytopenia in pregnancy, accounting for approximately 20% of the cases.
  1. Immune thrombocytopenic purpura: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder stimulated due to platelet destruction in the spleen. However, it is not a frequent cause of thrombocytopenia in pregnancy.
  1. Fatty liver: Acute fatty liver of pregnancy (AFLP) is a rare but serious condition, where the platelet count may drop below 20,000 per microliter of blood.
  1. Other causes: Nutritional deficiencies (most importantly vitamin B12 and folate), autoimmune diseases, thrombotic thrombocytopenic purpura, certain medications, viral infections (HIV and CMV), and bone marrow diseases may be some of the other causes of thrombocytopenia in pregnancy.

Symptoms Of Thrombocytopenia In Pregnancy

In most cases, pregnant women with thrombocytopenia may be asymptomatic. Some women may show the following common signs of thrombocytopenia (4).

  • Bleeding from a cut, the gums, or nose that won’t stop
  • Tiny round spots (petechiae) that are caused due to bleeding under the skin
  • Presence of blood in the urine or stool
  • Red or brown bruises (purpura)
  • Frequent bruising
  • Fatigue

Complications Of Thrombocytopenia During Pregnancy

If the platelet count falls extremely during pregnancy and continues to remain low until delivery, it might increase the chances of the following complications (1):

  • Epidural hematoma and inability to have epidural anesthesia before delivery
  • Increased blood loss/postpartum hemorrhage at the time of or following delivery
  • Recurrent gestational thrombocytopenia if the woman has a history of thrombocytopenia
  • Fetal or neonatal thrombocytopenia (depending on the cause of maternal thrombocytopenia)
  • Other potential complications such as disseminated intravascular coagulation (DIC) and hemolytic and uremic syndrome (5)

Treatment For Thrombocytopenia During Pregnancy

Depending on the cause of thrombocytopenia, women with thrombocytopenia during pregnancy may not require treatment until the condition is severe. Multidisciplinary care in conjunction with a hematologist is usually needed in pregnant women requiring treatment. Some of the treatment options for thrombocytopenia in pregnancy may include the following (1) (6).

  • Oral prednisone: The first-line treatment for pregnant women with thrombocytopenia is with the drug prednisone. Although it is considered pregnancy-safe, a few studies have shown its association with certain adverse effects, such as gestational diabetes (1).
  • Intravenous immunoglobulins (IVIg) and other corticosteroids: Studies have shown that corticosteroids and intravenous immunoglobulin therapy are acceptable in pregnant women with ITP (7).
  • Blood or platelet transfusions: Platelet transfusion is indicated in case of emergency cesarean delivery and when the platelet count falls below 50,000 per microliter.
  • Plasma exchange: Research suggests that plasma exchange therapy might be used in cases of severe HELLP syndrome and AFLP.

Precautions For Thrombocytopenia In Pregnancy

Taking certain measures in pregnancy may help in the management of thrombocytopenia in pregnancy (8) (9).

  • If you have a history of thrombocytopenia or a family history of blood disorders, you must disclose this to your doctor as there may be certain medications that you need to avoid taking, such as aspirin.
  • Avoid taking any additional medicines, supplements, or herbal remedies without consulting your doctor. These may affect the platelet counts and increase your risk of bleeding.
  • Do not indulge in contact sports and strenuous activities, which may put you at risk of injuries and bruises.
  • It is wise to avoid exposure to any toxic and household chemicals, such as pesticides, as they may lead to a drop in platelet counts in some cases.
  • Avoid alcohol intake to mitigate the risk of lowered platelet production and liver damage.
  • Be gentle while brushing your teeth, shaving, and blowing your nose to avoid sudden bleeding.

Natural Remedies To Increase Low Platelet Count

The consumption of certain foods during pregnancy may help improve platelet count and improve overall blood health; take note that this does not replace the need to see your doctor regularly and/or medical treatments if necessary (10).

  • Fresh green leafy vegetables such as spinach and kale
  • Fruits and veggies such as oranges, berries, beetroots, carrots, and tomatoes
  • Foods rich in vitamin C, such as lemon, red bell pepper, sprouts, and broccoli
  • Enriched dairy items, peanuts, walnuts, and dark chocolate
  • Fortified cereals, lentils, black-eyed peas, eggs, and beef liver
  • Foods rich in omega-3 fatty acids such as flaxseeds and fortified cereals

Note: Pregnant women are advised to avoid intake of fish that potentially contain high mercury levels, such as swordfish, tilefish, king mackerel, and shark. You may contact your doctor if you are unsure about including any new foods in your diet during pregnancy.

Effect Of Thrombocytopenia On The Baby

Mild thrombocytopenia is common in normal pregnancy and has no adverse effects on the mother and fetus. Conversely, severe thrombocytopenia, along with other underlying medical conditions, may lead to adverse fetal-maternal outcomes (1). A few research studies have stated that low maternal platelet count in the first trimester of pregnancy may sometimes lead to complications such as miscarriage (11). However, no research studies prove that thrombocytopenia in pregnancy alone can cause any birth defects in babies (12).

Mild thrombocytopenia is relatively common in most pregnancies, but several studies have shown no serious consequences for the mother and the child. Nevertheless, if you have a low platelet count during pregnancy, you must make sure to keep a watch on your symptoms. Take good care and have regular follow-up visits with your healthcare provider so that your thrombocytopenia can be closely monitored.

References:

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  1. Anca Marina Ciobanu; (2016); Thrombocytopenia in Pregnancy.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394486/
  2. F. Boehlen; (2006); Thrombocytopenia during pregnancy. Importance diagnosis and management.
    https://pubmed.ncbi.nlm.nih.gov/16444327/
  3. Thrombocytopenia in Pregnancy.
    http://www.csh.org.tw/dr.tcj/educartion/f/web/Thrombocytopenia%20in%20pregnancy/index.htm
  4. Thrombocytopenia in pregnancy.
    https://elearning.rcog.org.uk/sites/default/files/Haematological%20disorders/Myers_TOG_2009.pdf
  5. Laure Federici, et al.; (2008); Thrombocytopenia during pregnancy: from etiologic diagnosis to therapeutic management.
    https://pubmed.ncbi.nlm.nih.gov/18621503/
  6. Terry Gernsheimer, et al.; (2013); How I treat thrombocytopenia in pregnancy.
    https://ashpublications.org/blood/article/121/1/38/31058/How-I-treat-thrombocytopenia-in-pregnancy
  7. Dongmei Sun, et al.; (2016); Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy.
    https://ashpublications.org/blood/article/128/10/1329/35306/Corticosteroids-compared-with-intravenous
  8. Thrombocytopenia.
    https://my.clevelandclinic.org/health/diseases/14430-thrombocytopenia
  9. Important Outside Influences: Understanding What Impacts Your Platelets.
    https://pdsa.org/about-itp/warnings.html
  10. How can having low platelets affect my pregnancy and birth plan?
    https://utswmed.org/medblog/low-platelets-pregnancy/
  11. Piazze Juan, et al.; (2011); Platelets in pregnancy.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399052/
  12. Jessica A. Reese, et al.; (2019); Platelet Counts during Pregnancy
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049077/
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Dr. Ng Kai Lyn

(MMed (O&G), MRCOG)
Dr. Ng Kai Lyn is a Singapore-based obstetrician and gynecologist, specializing in urogynecology, minimally invasive surgery, and clinical interest in fertility. She has vast experience managing and treating benign gynecological conditions, including uterine fibroids, ovarian cysts, endometrial polyps, and endometriosis. She is also fellowship trained in urogynecology. She manages pelvic organ prolapse, pelvic floor reconstructive surgery, overactive bladder, urinary incontinence,... more

Vidya Tadapatri

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over four years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology. Vidya writes health-based articles... more