Thrombocytopenia (defined as platelet count < 150 × 109/L)
is present in 7% - 12% of pregnant women at delivery. Although there are mild
etiologies of this condition that are often diagnosed incidentally, there are
more severe causes that can be life threating. Thrombocytopenia also has a
great implication in surgical risk and regional anesthesia. A structured
evaluation of thrombocytopenia is necessary
to allow an adequate diagnostic approach. Here we summarized the current
knowledge of thrombocytopenia in pregnancy.
References
[1]
Abbassi-Ghanavati, M., Greer, L.G. and Cunningham, F.G. (2009) Pregnancy and Laboratory Studies: A Reference Table for Clinicians. Obstetrics & Gynecology, 114, 1326-1331. https://doi.org/10.1097/AOG.0b013e3181c2bde8
[2]
ACOG Practice Bulletin (2019)) ACOG Practice Bulletin No. 207: Thrombocytopenia in Pregnancy. Obstetrics & Gynecology, 133, e181-e193.
https://doi.org/10.1097/AOG.0000000000003100
[3]
Reese, J.A., Peck, J.D., Deschamps, D.R., McIntosh, J.J., Knudtson, E.J., Terrell, D.R., et al. (2018) Platelet Counts during Pregnancy. New England Journal of Medicine, 379, 32-43. https://doi.org/10.1056/NEJMoa1802897
[4]
Reese, J.A., Peck, J.D., McIntosh, J.J., Vesely, S.K. and George, J.N. (2017) Platelet Counts in Women with Normal Pregnancies: A Systematic Review. American Journal of Hematology, 92, 1224-1232. https://doi.org/10.1002/ajh.24829
[5]
Habas, E., Rayani, A. and Ganterie, R. (2013) Thrombocytopenia in Hypertensive Disease of Pregnancy. The Journal of Obstetrics and Gynecology of India, 63, 96-100. https://doi.org/10.1007/s13224-012-0257-2
[6]
Juan, P., Stefano, G., Antonella, S. and Albana, C. (2011) Platelets in Pregnancy. Journal of Prenatal Medicine, 5, 90-92.
[7]
Cines, D.B. and Levine, L.D. (2017) Thrombocytopenia in Pregnancy. Blood, 130, 2271-2277. https://doi.org/10.1182/blood-2017-05-781971
[8]
Ciobanu, A.M., Colibaba, S., Cimpoca, B., Peltecu, G. and Panaitescu, A.M. (2016) Thrombocytopenia in Pregnancy. Maedica, 11, 55-60.
[9]
Slichter, S.J., Kaufman, R.M., Assmann, S.F., McCullough, J., Triulzi, D.J., Strauss, R.G., et al. (2010) Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage. New England Journal of Medicine, 362, 600-613.
https://doi.org/10.1056/NEJMoa0904084
[10]
Estcourt, L.J., Stanworth, S.J., Doree, C., Hopewell, S., Trivella, M. and Murphy, M.F. (2015) Comparison of Different Platelet Count Thresholds to Guide Administration of Prophylactic platelet Transfusion for Preventing Bleeding in People with Haematological Disorders after Myelosuppressive Chemotherapy or Stem Cell Transplantation. Cochrane Database of Systematic Reviews, No. 11, Article No. CD010983. https://doi.org/10.1002/14651858.CD010983.pub2
[11]
Estcourt, L.J., Malouf, R., Hopewell, S., Doree, C. and Van Veen, J. (2018) Use of Platelet Transfusions Prior to Lumbar Punctures or Epidural Anaesthesia for the Prevention of Complications in People with Thrombcytopenia. Cochrane Database of Systematic Reviews, No. 4, Article No. CD011980.
https://doi.org/10.1002/14651858.CD011980.pub3
[12]
Ho, A.M., Mizubuti, G.B. and Ho, A.K. (2019) Safety of Spinal Anesthesia in Thrombocytopenic Patients: Are There Lessons to be Learnt from Oncology? Regional Anesthesia & Pain Medicine, 44, 29-31. https://doi.org/10.1136/rapm-2018-000011
[13]
Lee, L.O., Bateman, B.T., Kheterpal, S., Klumpner, T.T., Housey, M., Aziz, M.F., et al. (2017) Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group. Anesthesiology, 126, 1053-1063. https://doi.org/10.1097/ALN.0000000000001630
[14]
Harde, M., Dave, S., Vasave, R.R., Gujjar, P. and Bhadade, R. (2013) Lower Segment Cesarean Section in a Patient with Severe Thrombocytopenia and Pregnancy Induced Hypertension. Journal of Anaesthesiology Clinical Pharmacology, 29, 387-389. https://doi.org/10.4103/0970-9185.117110
[15]
Sanikop, C., Misra, S. and Akram, N. (2015) Anesthetic Management of a Patient with Gestational Thrombocytopenia for Elective Cesarean Section. Karnataka Anaesthesia Journal, 1, 33-34. https://doi.org/10.4103/2394-6954.149719
[16]
Xu, X., Zhang, Y., Yu, X. and Huang, Y. (2019) Preoperative Moderate Thrombocytopenia Is Not Associated with Increased Blood Loss for Low-Risk Cesarean Section: A Retrospective Cohort Study. BMC Pregnancy and Childbirth, 19, Article No. 269. https://doi.org/10.1186/s12884-019-2417-1
[17]
Bergmann, F. and Rath, W. (2015) The Differential Diagnosis of Thrombocytopenia in Pregnancy. Deutsches Ärzteblatt International, 112, 795-802.
https://doi.org/10.3238/arztebl.2015.0795
[18]
Rimaitis, K., Grauslyte, L., Zavackiene, A., Baliuliene, V., Nadisauskiene, R. and Macas, A. (2019) Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre. International Journal of Environmental Research and Public Health, 16, Article No. 109. https://doi.org/10.3390/ijerph16010109
[19]
Rodeghiero, F., Stasi, R., Gernsheimer, T., Michel, M., Provan, D., Arnold, D.M., et al. (2009) Standardization of Terminology, Definitions and Outcome Criteria in Immune Thrombocytopenic Purpura of Adults and Children: Report from an International Working Group. Blood, 113, 2386-2393.
https://doi.org/10.1182/blood-2008-07-162503
[20]
Stavrou, E. and McCrae, K.R. (2009) Immune Thrombocytopenia in Pregnancy. Hematology/Oncology Clinics of North America, 23, 1299-1316.
https://doi.org/10.1016/j.hoc.2009.08.005
[21]
Khan, A.M., Mydra, H. and Nevarez, A. (2017) Clinical Practice Updates in the Management of Immune Thrombocytopenia. P & T, 42, 756-763.
[22]
Padmanabhan, A., Connelly-Smith, L., Aqui, N., Balogun, R.A., Klingel, R., Meyer, E., et al. (2019) Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. Journal of Clinical Apheresis, 34, 171-354. https://doi.org/10.1002/jca.21705
[23]
George, J.N., Nester, C.M. and McIntosh, J.J. (2015) Syndromes of Thrombotic Microangiopathy Associated with Pregnancy. Hematology: The American Society of Hematology Education Program, 2015, 644-648.
https://doi.org/10.1182/asheducation-2015.1.644
[24]
Gando, S., Levi, M. and Toh, C.H. (2016) Disseminated Intravascular Coagulation. Nature Reviews Disease Primers, 2, Article No. 16037.
https://doi.org/10.1007/978-3-319-28308-1_13
Chaudhary, R.K., Nepal, C., Khanal, N., Pathak, R., Giri, S. and Bhatt, V.R. (2015) Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review. Cardiovascular & Hematological Agents in Medicinal Chemistry, 13, 92-97. https://doi.org/10.2174/187152571302151217124957
[27]
Garcia, D. and Erkan, D. (2018) Diagnosis and Management of the Antiphospholipid Syndrome. New England Journal of Medicine, 378, 2010-2021.
https://doi.org/10.1056/NEJMra1705454
[28]
Fakhouri, F., Zuber, J., Frémeaux-Bacchi, V. and Loirat, C. (2017) Haemolytic uraemic Syndrome. The Lancet, 390, 681-696.
https://doi.org/10.1016/S0140-6736(17)30062-4
[29]
Spinale, J.M., Ruebner, R.L., Kaplan, B.S. and Copelovitch, L. (2013) Update on Streptococcus pneumoniae Associated Hemolytic Uremic Syndrome. Current Opinion in Pediatrics, 25, 203-208. https://doi.org/10.1097/MOP.0b013e32835d7f2c
[30]
Montagnana, M., Franchi, M., Danese, E., Gotsch, F. and Guidi, G.C. (2010) Disseminated Intravascular Coagulation in Obstetric and Gynecologic Disorders. Seminars in Thrombosis and Hemostasis, 36, 404-418.
https://doi.org/10.1055/s-0030-1254049
