Low Platelet Count (Thrombocytopenia) During Pregnancy

What is Thrombocytopenia?  

Thrombocytopenia, commonly known as a low platelet count, affects roughly 8% of pregnancies. Most thrombocytopenia cases are minor, and neither the pregnant woman nor her unborn child is at risk.  

The causes of thrombocytopenia are numerous. Immune thrombocytopenia, or ITP, is among the most frequent reasons for low platelets. A decrease in bone marrow-produced platelets and an increase in platelet oxidation are the two main contributors to thrombocytopenia.

Gestational Thrombocytopenia  

Thrombocytopenia occurs when the quantity of platelets in the blood falls below a certain level. The low level of platelets occurring during pregnancy is gestational thrombocytopenia (GT).  

GT is a benign disorder that frequently goes unnoticed and almost usually resolves after childbirth.

The bone marrow produces platelets, blood cells with a plate structure. For instance, when we cut our hands, platelets bind to form a clot that stops the bleeding when a blood vessel is damaged. We bruise and bleed more easily when there aren’t enough platelets in the blood.

An individual typically has between 150,000 and 400,000 platelets per microliter of blood. For people with thrombocytopenia, the platelet count falls below 150,000.

Platelet counts in almost all cases of GT range between 100,000 and 150,000, and the disease is moderate. There is likely another underlying issue in the rare event that they fall lower.

GT affects 5 to 10 per cent of pregnancies, and women expecting twins or triplets are at greater risk. If a woman has the illness once, the chance of getting it again in a subsequent pregnancy increases by 14 times.

Causes of Thrombocytopenia in Pregnancy  

It’s common for the platelet count to drop by a few thousand throughout pregnancy. This is partially due to hemodilution; as the body produces more plasma during pregnancy, there are fewer platelets per unit of blood.

The doctor will want to keep a closer eye on the patient when the reading falls below 100,000-150,000/L to lower the possibility of problems.

About 10% of women experience platelet counts below 150,000/L during pregnancy.  

From those, approximately

• 25% are associated with hypertensive illnesses such as preeclampsia or HELLP syndrome, while common changes in pregnancy bring on 75%.

• 4 per cent are caused by genetic or immunological disorders, in which the immune system produces antibodies that target platelet cells.

• Platelet counts of less than 100,000/L are present in about 1% of individuals, which may affect how they manage their pregnancies.

During pregnancy, platelets may be lost more quickly. More platelets may be destroyed during the filtering process as the spleen grows in size as a result of the increased blood volume during pregnancy.

Prenatal vitamins should be taken since thrombocytopenia can also arise due to folic acid deficiency in the blood. Some bacterial and viral conditions, including Epstein-Barr, HIV, hepatitis B and C, can decrease the platelet count.

Thrombocytopenia symptoms during pregnancy  

Many thrombocytopenic pregnant women show no signs of the condition.

The low platelets could have another underlying reason if a woman experience any of the following during pregnancy.

• Bleeding gums like that happen during brushing or flossing the teeth.
• Urine or faeces containing blood  
• Easy bruising
• Drowsiness  
• Nosebleeds  
• Petechiae, or tiny red patches, are signs of subcutaneous haemorrhage.

Consult a doctor on experiencing any new symptoms while pregnant. Uncontrolled bleeding is an emergency situation requiring quick medical attention.

Pregnancy and platelet count  

The body produces more blood plasma during pregnancy. Hemodilution and increased blood volume result due to this. This signifies that the same amount of platelet cells is present in more blood than usual. The platelet count per microliter of blood decreases as a result.  

The platelets are destroyed, and the platelet count drops. The spleen grows in size during pregnancy because of the increased blood flow. The blood’s platelet cells may be more quickly destroyed by the bigger spleen when it filters the blood.  

Rarely, thrombocytopenia can result from a significant folic acid deficiency in the diet.  

The natural decrease in blood platelets that frequently happens during pregnancy is thought to be magnified slightly by gestational thrombocytopenia. It does not cause bleeding issues and is typically not linked to an increased risk of difficulties during pregnancy.  

Will Gestational Thrombocytopenia affect the baby?  

Thrombocytopenia during pregnancy won’t harm the unborn child. The likelihood that the unborn child or foetus may have low platelets is reduced for women diagnosed with GT. According to studies, it only affects 0.1% to 1.7% of babies.

It’s safe to breastfeed as well. There is a chance that a woman is unable to obtain an epidural when the platelet count is low during the time of delivery. Still, a healthcare professional will treat it without harming the baby.

Diagnosis of Thrombocytopenia  

Since no single test can accurately diagnose gestational thrombocytopenia, a doctor will first work with the patient to rule out other potential causes of low platelets.

Gestational thrombocytopenia is the root cause of 70% to 80% of occurrences of thrombocytopenia during pregnancy.

• The doctor will likely recommend more tests if the platelet count is less than 100,000 platelets per microliter of blood. It is unlikely that the patient will be diagnosed with gestational thrombocytopenia if the platelet count is below 40,000 to 50,000.

• Immune thrombocytopenia (ITP), which accounts for around 3% of all cases of thrombocytopenia during pregnancy, is the second most common cause of this condition. ITP is more likely the cause when the platelet count is under 100,000.

• Medical or family history will help determine a pre-pregnancy low platelet count or family history of bleeding problems or autoimmune conditions.

• At all gestational ages, a peripheral blood smear is the primary laboratory test to determine that a low platelet count is true and to rule out microangiopathy.  

• Prothrombin time, antithrombin, fibrinogen, APTT, and D-dimer screening should be carried out to check for coagulation abnormalities.  

• It is advised to screen for infectious reasons and check for abnormal liver function test results (bilirubin, albumin, total protein, transferases, and alkaline phosphatase), as well as for antiphospholipid antibodies, lupus anticoagulant, and SLE serology.  

• It is important to regularly check for thyroid dysfunction because it is frequently linked to pregnancy and ITP. A direct antiglobulin test is the only way to rule out autoimmune hemolysis.

Treatment for Gestational Thrombocytopenia  

Observation is the only way of treatment for most patients with low platelets. A doctor may advise taking folate and vitamin B12 supplements to increase the platelet count.

Several foods can assist in raising the platelet counts.

• Green leafy vegetables, including spinach and kale.
• Dark chocolate
• Eggs
• Fortified breakfast cereals
• Pulses and lentils
• Lean meat and liver
• Dairy alternatives
• Vitamin C foods such as oranges, brussels sprouts and red peppers.

Treatment options:

• Patients with hypertension require improved monitoring and may need to deliver early to lower their risk of cardiovascular damage. The platelet count usually returns to normal within a few days of delivery.

• Steroids or IV immunoglobulins (antibody) therapy may be necessary for immunological diseases that might lower platelets, such as immune thrombocytopenia purpura (ITP).  

• Antibodies may be given to stop the immune system from attacking the healthy platelets.  

• A doctor advises spleen removal during pregnancy in extreme cases.

• Most mild cases of thrombocytopenia can be managed without therapy. The condition tends to go away after delivery.

• The primary treatment is plasma exchange, and consistent plasma exchange may successfully continue a pregnancy. Splenectomy procedures can sometimes be done safely, particularly during the second trimester of pregnancy, in cases with thrombocytopenia that are unresponsive to other treatments.

• More intense treatment may be necessary in severe situations. The objective is to boost the platelet count and maintain health.

Some possible common treatments include,

• Plasma exchange
• Platelet transplantation
• Oral steroids
• Immunoglobulin injection during intravenous immunoglobulin treatment.

Conclusion  

Gestational thrombocytopenia is one of the most frequent haematological abnormalities seen during pregnancy. This occurs in nearly 10 % of pregnancies.  

Gestational thrombocytopenia recovers on its own within 1 to 2 months and is likely to recur in future pregnancies. At most times, when thrombocytopenia occurs during pregnancy, it is mild and has no harmful effects on the mother, the foetus, or the newborn.

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