Table 3.
Diagnostic approach to thrombocytopenia in pregnancy
| 1. History | Bleeding symptoms Infectious symptoms Prior platelet counts: pregnant and nonpregnant Family history of thrombocytopenia Autoimmune disorders Medications Headache | ||
| 2. Physical examination | Bleeding: bruising, petechiae, purpura, oral mucosal blood blisters, conjunctival hemorrhages Blood pressure Lymphadenopathy, hepatomegaly, splenomegaly Abdominal tenderness Lower extremity edema Rashes or synovitis | ||
| 3. Timing | Categorize by onset and severity of thrombocytopenia (Figure 2) | ||
| 4. Peripheral smear examination | Platelet clumping (Pseudothrombocytopenia) | Normal morphology of all 3 cell lines | Schistocytes (TMA) |
| Laboratory assessment | None indicated | Investigate potential contributors Infection Screen for HIV, HBV, HCV, H pylori Thorough assessment of any current infectious symptoms Liver injury LFTs Coagulation profile Autoimmune processes APLA panel ANA | Hemolytic panel LDH Reticulocyte count Haptoglobin LFTs (bilirubin) Urinalysis Renal function ADAMTS13 activity Coagulation profile |
| Management | Standard obstetric care | Trend platelet count Reserve treatment for clinically significant processes/bleeding or as needed to prepare for delivery | Initiate therapy for the most likely TMA Revisit the diagnosis and escalate or redirect therapies pending clinical course |
| 1. History | Bleeding symptoms Infectious symptoms Prior platelet counts: pregnant and nonpregnant Family history of thrombocytopenia Autoimmune disorders Medications Headache | ||
| 2. Physical examination | Bleeding: bruising, petechiae, purpura, oral mucosal blood blisters, conjunctival hemorrhages Blood pressure Lymphadenopathy, hepatomegaly, splenomegaly Abdominal tenderness Lower extremity edema Rashes or synovitis | ||
| 3. Timing | Categorize by onset and severity of thrombocytopenia (Figure 2) | ||
| 4. Peripheral smear examination | Platelet clumping (Pseudothrombocytopenia) | Normal morphology of all 3 cell lines | Schistocytes (TMA) |
| Laboratory assessment | None indicated | Investigate potential contributors Infection Screen for HIV, HBV, HCV, H pylori Thorough assessment of any current infectious symptoms Liver injury LFTs Coagulation profile Autoimmune processes APLA panel ANA | Hemolytic panel LDH Reticulocyte count Haptoglobin LFTs (bilirubin) Urinalysis Renal function ADAMTS13 activity Coagulation profile |
| Management | Standard obstetric care | Trend platelet count Reserve treatment for clinically significant processes/bleeding or as needed to prepare for delivery | Initiate therapy for the most likely TMA Revisit the diagnosis and escalate or redirect therapies pending clinical course |
ANA, antinuclear antibody; APLA, antiphospholipid antibody antibodies; LDH, lactate dehydrogenase.