ThrombocytopeniaDuring Pregnancy
Dina KhairyHemaya Gerguis;
Abstract
Thrombocytopenia isa common finding in pregnancy, occurringinapproximately 7-8% ofall pregnancies.Itmay bea diagnosticandmanagement dilemma,andhasmany causes,someofwhicharespecific topregnancy.
Althoughthrombocytopenia diagnosedin pregnancy inmostcaseshasamildcourseandgoodoutcome,the morerarely observeddeepthrombocytopeniawithsystemic involvementdeterminestheseverityofthepatient’sgeneral conditionandmay significantlyaffectperinatal complications. Itusually involvesa specific groupof patientswith the diagnosisofDIC,HELLPandTTP.The differential diagnosisand properassessment of clinicalrisk ofthrombocytopeniaduringpregnancy aredifficultand requirecooperation betweenmedical professionalsof different specialties, but they are of great concern for furthertreatmentandprognosis.Thebetterunderstanding of pathophysiology oftheseconditions brings hopefor futuretherapeutic strategies.
Overall,about70–80% ofcasesaredueto gestationalthrombocytopenia,6% secondary to hypertensivedisorders;3–4%duetoanimmuneprocess,
and theremaining1–2%madeupofrareconstitutional thrombocytopenias, infectionsandmalignancies.
Inthisreview,a diagnostic approachto investigating thrombocytopenia in pregnancy ispresented,togetherwith antenatal, anaesthetic and peri-natal management for motherandbaby,followedby adetaileddiscussiononthe specificcausesofthrombocytopeniaand themanagement optionsineachcase.
Theplateletcountinpregnancy isslightlylowerthan in non-pregnantwomen.Moststudiesreportadecrease in plateletcountduringpregnancy,resultinginlevelsabout
10%lowerthanpre-pregnancylevelatterm.Themajority ofwomenstill havelevelswithin the normalrange; however, ifpre-pregnancy levelsare border-line, or thereis a more severe reduction, the level may fall below the normalrange.
Thekey initialassessmentisabloodfilm toconfirm thatthethrombocytopeniaisgenuine andtourgently exclude thepresence ofmicroangiopathy.Inthosewith no adversefeatures,antenatalmanagement depends onthe extentof the thrombocytopenia.
Althoughthrombocytopenia diagnosedin pregnancy inmostcaseshasamildcourseandgoodoutcome,the morerarely observeddeepthrombocytopeniawithsystemic involvementdeterminestheseverityofthepatient’sgeneral conditionandmay significantlyaffectperinatal complications. Itusually involvesa specific groupof patientswith the diagnosisofDIC,HELLPandTTP.The differential diagnosisand properassessment of clinicalrisk ofthrombocytopeniaduringpregnancy aredifficultand requirecooperation betweenmedical professionalsof different specialties, but they are of great concern for furthertreatmentandprognosis.Thebetterunderstanding of pathophysiology oftheseconditions brings hopefor futuretherapeutic strategies.
Overall,about70–80% ofcasesaredueto gestationalthrombocytopenia,6% secondary to hypertensivedisorders;3–4%duetoanimmuneprocess,
and theremaining1–2%madeupofrareconstitutional thrombocytopenias, infectionsandmalignancies.
Inthisreview,a diagnostic approachto investigating thrombocytopenia in pregnancy ispresented,togetherwith antenatal, anaesthetic and peri-natal management for motherandbaby,followedby adetaileddiscussiononthe specificcausesofthrombocytopeniaand themanagement optionsineachcase.
Theplateletcountinpregnancy isslightlylowerthan in non-pregnantwomen.Moststudiesreportadecrease in plateletcountduringpregnancy,resultinginlevelsabout
10%lowerthanpre-pregnancylevelatterm.Themajority ofwomenstill havelevelswithin the normalrange; however, ifpre-pregnancy levelsare border-line, or thereis a more severe reduction, the level may fall below the normalrange.
Thekey initialassessmentisabloodfilm toconfirm thatthethrombocytopeniaisgenuine andtourgently exclude thepresence ofmicroangiopathy.Inthosewith no adversefeatures,antenatalmanagement depends onthe extentof the thrombocytopenia.
Other data
| Title | ThrombocytopeniaDuring Pregnancy | Other Titles | نقص عدد الصفائح الدموية أثناء الحمل | Authors | Dina KhairyHemaya Gerguis | Issue Date | 2017 |
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