Characteristic features and management of specific thrombocytopenias in pregnancy
| . | Presenting stage of pregnancy . | Degree of thrombocytopenia . | Associated clinical features . | Primary treatment . | |
|---|---|---|---|---|---|
| GT | Late | Mild | Normal physical examination and laboratory profile | Observation | |
| ITP | Any trimester or PP | Mild to severe | Bleeding when thrombocytopenia is significant Consider acute or chronic infections as potential triggers, or syndrome with other autoimmune diseases | First-line therapy Corticosteroids and IVIG Second-line therapies Azathioprine Cyclosporine Rituximab Splenectomy (rarely performed) TPO mimetics (off-label use) | |
| TMAs | PEC/HELLP | Must be 20+ wk Typically third trimester Possible early PP | Mild/moderate | Transaminitis Normal to severe Renal injury Rare/mild Coagulopathy Rare/mild Neurologic Headache common Seizure/CVA rare | Fetal delivery In addition to delivery Aggressive HTN control Aspirin Magnesium ∗Betamethasone as needed for fetal lung maturity |
| AFLDP | Late in pregnancy or immediately PP | Mild/moderate | Transaminitis Severe (RUQ pain, nausea, and vomiting are common) Renal injury Mild/moderate Coagulopathy Often severe Neurologic Encephalopathy | Fetal delivery Unlikely to fully resolve liver injury Liver transplantation may be required Assess for fatty acid oxidation enzyme defects | |
| TTP | Any trimester or PP | Severe | Transaminitis Rare Renal injury Mild or absent Coagulopathy Rare Neurologic Transient focal defects possible, progressive without treatment | Plasma exchange for acquired TTP Fresh frozen plasma simple transfusion for congenital TTP | |
| cm-HUS | Typically PP Evenly distributed in trimesters when ante partum | Moderate | Transaminitis Rare/mild Renal injury Severe Coagulopathy Rare/mild Neurologic Rare | Eculizumab Renal replacement therapy may be required | |
| CAPS | Any trimester or PP | Mild to severe | Transaminitis Rare/mild Renal injury Rare to severe Coagulopathy Common Neurologic Increased risk for CVA | Therapeutic anticoagulation | |
| . | Presenting stage of pregnancy . | Degree of thrombocytopenia . | Associated clinical features . | Primary treatment . | |
|---|---|---|---|---|---|
| GT | Late | Mild | Normal physical examination and laboratory profile | Observation | |
| ITP | Any trimester or PP | Mild to severe | Bleeding when thrombocytopenia is significant Consider acute or chronic infections as potential triggers, or syndrome with other autoimmune diseases | First-line therapy Corticosteroids and IVIG Second-line therapies Azathioprine Cyclosporine Rituximab Splenectomy (rarely performed) TPO mimetics (off-label use) | |
| TMAs | PEC/HELLP | Must be 20+ wk Typically third trimester Possible early PP | Mild/moderate | Transaminitis Normal to severe Renal injury Rare/mild Coagulopathy Rare/mild Neurologic Headache common Seizure/CVA rare | Fetal delivery In addition to delivery Aggressive HTN control Aspirin Magnesium ∗Betamethasone as needed for fetal lung maturity |
| AFLDP | Late in pregnancy or immediately PP | Mild/moderate | Transaminitis Severe (RUQ pain, nausea, and vomiting are common) Renal injury Mild/moderate Coagulopathy Often severe Neurologic Encephalopathy | Fetal delivery Unlikely to fully resolve liver injury Liver transplantation may be required Assess for fatty acid oxidation enzyme defects | |
| TTP | Any trimester or PP | Severe | Transaminitis Rare Renal injury Mild or absent Coagulopathy Rare Neurologic Transient focal defects possible, progressive without treatment | Plasma exchange for acquired TTP Fresh frozen plasma simple transfusion for congenital TTP | |
| cm-HUS | Typically PP Evenly distributed in trimesters when ante partum | Moderate | Transaminitis Rare/mild Renal injury Severe Coagulopathy Rare/mild Neurologic Rare | Eculizumab Renal replacement therapy may be required | |
| CAPS | Any trimester or PP | Mild to severe | Transaminitis Rare/mild Renal injury Rare to severe Coagulopathy Common Neurologic Increased risk for CVA | Therapeutic anticoagulation | |
AFLDP, acute fatty liver disease of pregnancy; CAPS, catastrophic antiphospholipid antibody syndrome; cm-HUS, complement-mediated hemolytic uremic syndrome; CVA, cerebrovascular accident; HTN, hypertension; PEC/HELLP, preeclampsia/hemolysis, elevated liver enzymes and low platelets; PP, postpartum; RUQ, right upper quadrant.