Citation Information :
Joshi SS, Panchbudhe SA. Characterization of Thrombocytopenia in Pregnant Women at a Tertiary Care Center: A Preliminary Study of 121 Patients. J South Asian Feder Obs Gynae 2022; 14 (4):486-490.
Background: Partum-related hemorrhage is a major cause of maternal morbidity and mortality, the risk of which increases in women with thrombocytopenia. An accurate etiological diagnosis of thrombocytopenia in pregnancy is essential for optimal therapeutic management to prevent maternal and fetal morbidity and mortality. Our study aims to establish various prevalent causes of thrombocytopenia in pregnancy and its demographic characteristics.
Materials and methods: In total, 121 pregnant patients visiting the Antenatal Outpatient Department and/or Emergency Department at a tertiary medical center with thrombocytopenia (platelet counts <1,50,000/µL) were recruited for the study. Detailed blood investigations were done to establish the accurate etiology of thrombocytopenia. Special attention was given to differentiating between pregnancy-associated causes and those incidental to pregnancy.
Results: Gestational thrombocytopenia (GT) accounted for 56.2% of the total cases, and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome accounted for 13.2% of the cases, closely followed by idiopathic thrombocytopenic purpura (12.4%). Thrombocytopenia associated with nutritional deficiencies was seen in 5.8% of the cases. Other less common causes included fever-associated thrombocytopenia (2.5%), disseminated intravascular coagulation (DIC) (2.5%), acute fatty liver of pregnancy (AFLP) (0.8%), atypical hemolytic uremic syndrome (HUS) (0.8%), and antiphospholipid antibody (APLA) syndrome (0.8%).
Conclusion: Gestational thrombocytopenia (GT) is the commonest cause of thrombocytopenia during pregnancy.
Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood 2013;121(1):38–47. DOI: 10.1182/blood-2012-08-448944.
Myers B. Thrombocytopenia in pregnancy. Obstet Gynecol 2009;11:177–183. DOI: 10.1576/toag.188.8.131.52502.
McCrae KR, Bussel JB, Mannucci PM, et al. Platelets: an update on diagnosis and management of thrombocytopenia disorders. Hematol Am Soc Hematol Educ Program 2001;282–305. DOI: 10.1182/asheducation-2001.1.282.
Reese JA, Peck JD, Yu Z, et al. Platelet sequestration in the placental intervillous space contribute to platelet counts during pregnancy. Am J Hematol 2019;94(1):E8–E11. DOI: 10.1002/ajh.25321.
Ciobanu AM, Colibaba S, Cimpoca B, et al. Thrombocytopenia in pregnancy. Maedica (Bucur) 2016;11(1):55–60. PMCID: PMC5394486.
Ho-Tin-Noé B, Jadoui S. Spontaneous bleeding in thrombocytopenia: is it really spontaneous? Transfus Clin Biol 2018;25(3):210–216. DOI: 10.1016/j.tracli.2018.06.005.
Nisha S, Amita D, Uma S, et al. Prevalence and characterisation of thrombocytopenia in pregnancy in Indian women. Indian J Hematol Blood Transfus 2012;28(2):77–81. DOI: 10.1007/s12288-011-0107-x.
Mohseni M, Asgarlou Z, Azami-Aghdash S, et al. The global prevalence of thrombocytopenia among pregnant women: a systematic review and meta-analysis. Nurse Midwifery Stud [serial online] 2019;8(2): 57–63. DOI: 10.4103/nms.nms_57_18.
Chen Z, Liang M-Y, Wang J-L. Etiology and characteristics of pregnancy emerged thrombocytopenia. Zhongua Fu Chan Ke Za Zhi 2011;46(11):834–839. PMID: 22333233.
Harde M, Bhadade R, deSouza R, et al. Thrombocytopenia in pregnancy nearing term: a clinical analysis. Indian J Crit Care Med 2019;23(11):503–508. DOI: 10.5005/jp-journals-10071-23277.
Mbanya D, Tayou Tagny C, Takoeta E, et al. Facteurs associés aux thrombocytopénies chez les femmes enceintes au Cameroun [Factors associated with thrombocytopenia among pregnant women in Cameroon]. Sante 2007;17(4):213–217. DOI: 10.1684/san.2007.0085.
Begam A, Sujatha TL, Nambisan B, et al. Risk factors of thrombocytopenia in pregnancy. Int J Reprod Contracept Obstet Gynecol 2017;6(2):700–706. DOI: 10.18203/2320-1770.ijrcog20170408.
Shamoon RP, Muhammed NS, Jaff MS. Prevalence and etiological classification of thrombocytopenia among a group of pregnant women in Erbil City, Iraq. Turk J Haematol 2009;26(3):123–128. PMID: 27265495.
Reese JA, Peck JD, Deschamps DR, et al. Platelet counts during pregnancy. N Engl J Med 2018;379:32–43. DOI: 10.1056/NEJMoa1802897.
Mohammad S, Bhute A, Acharya N. Moschowitz Syndrome or Thrombotic Thrombocytopenia Purpura and Antiphospholipid Antibody Syndrome as a rare cause of thrombocytopenia in pregnancy mimicking hemolysis, elevated liver enzymes, and low platelets in a patient with bad obstetric history: a diagnostic dilemma. J South Asian Feder Obs Gynae 2020;12(4):250–253. DOI: 10.5005/jp-journals-10006-1791.