Thrombocytopenia in Pregnancy: Identification and Management at a Reference Center in Pakistan

Abstract

Objective: The study aimed to evaluate the causes of thrombocytopenia in pregnancy and its management along with the outcome in the COVID-19 era. Methods: Recruitment for this prospective, cross-sectional observational study of thrombocytopenia in pregnancy (platelet counts <100x10 9 /L) was done from January 2017 to August 2020 at the National Institute of Blood Diseases (NIBD) after taking the patients’ informed consent. Complete clinical and lab profile of patients was also collected. Results: A total of 150 pregnant women with thrombocytopenia were enrolled, with the mean age being 27.3±4.64 years. Mean platelet counts at baseline were 48.0±24. Main clinical manifestations at baseline included: anemia 65.9%, bruises 23.25%, and edema 9.3%. Causes of thrombocytopenia were gestational thrombocytopenia (GT) 72 (48%), acute fatty liver five (3.3%), pre-eclampsia in 11 (7.3%), and eclampsia seven (4.6%). Causes not specific to pregnancy included 30 (20%) cases of ITP, hepatitis C, and nutritional deficiency was reported in nine (6%) patients each. 72/150 received supportive care treatment to manage thrombocytopenia and were closely monitored and given supplements. Twenty (66.6%) ITP patients received treatment with steroids, with complete response in 70% of them seen. Overall, 38 (25.3%) women with bleeding symptoms and platelet count <50x10 9 /L received platelet transfusions. Conclusion: The study shows that pre-eclampsia and eclampsia are serious conditions with a high risk for complications, while GT is a benign and the most common cause of thrombocytopenia in pregnancy which requires no active treatment. The other causes such as ITP and infections require individualized management.

Prevalence of Thrombocytopenia in Women during Third Trimester of Pregnancy

“…Among pregnant females, gestational thrombocytopenia, idiopathic thrombocytopenic purpura and pre-eclampsia are some of the most frequent causes behind gestational thrombocytopenia. 13,14 Some researchers have shown that gestational thrombocytopenia might increase the chances of excessive bleeding during or after the delivery especially among cases who undergo cesarean section or any other surgical procedure but these manifestations are more evident among cases of severe gestational thrombocytopenia. 15,16 We found the frequency of thrombocytopenia to be 10% among pregnant females attending the outpatient department for antenatal check-ups.…”

Frequency and Outcome of Pregnant Females Presenting With Thrombocytopenia at a Tertiary Care Hospital

“…This descriptive case series study was performed at the Obstetrics and Gynecology Unit III, Jinnah Hospital, Lahore, Pakistan, from April 2023 to September 2023. A sample size of 280 patients was calculated, taking the expected percentage of gestational thrombocytopenia in females presenting for delivery as 7% [ 1 ], with a confidence level of 95% and a margin of error of 3%. Sample selection was made employing a non-probability, consecutive sampling technique.…”

“…Platelet-related problems are more frequently discovered in women during pregnancy because screening is carried out as part of the initial clinic examination using automated blood counts [ 1 , 2 ]. Understanding the various causes of thrombocytopenia during pregnancy makes it easier to diagnose and treat thrombocytopenia in pregnant women [ 3 ].…”