Low Platelets in Pregnancy: A Clinical Reality Check from Abdul Mannan
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared on LinkedIn:
”Low Platelets in Pregnancy: A Clinical Reality Check
Every haematologist gets these calls.
An obstetrician finds a low platelet count at booking bloods.
Panic sets in. But here’s the thing most clinicians forget:
- 75% of cases are completely benign.
- Gestational thrombocytopenia is the most common cause. It doesn’t harm mum. It doesn’t harm baby. It just… exists.
But that doesn’t mean we can be complacent. The remaining 25% includes conditions that can kill: pre-eclampsia, TTP, HELLP syndrome, acute leukaemia.
So how do we tell the difference?
Blood Doctor 5-Step Approach:
- Rule out emergencies first. Pre-eclampsia. TTP. Leukaemia. These can’t wait.
- Look at the blood film. Schistocytes point to microangiopathy. Blasts mean something sinister. Platelet clumping? That’s just pseudothrombocytopenia.
- Consider severity and timing. Platelets below 20 × 10⁹/L or dropping early in pregnancy? That’s not gestational thrombocytopenia. Think ITP.
- Assess bleeding risk. Is she symptomatic? Any procedures coming up? This guides urgency.
- Watch the response to treatment. If platelets rise with steroids or IVIG, you’ve likely got ITP.
Practical targets for delivery:
- Vaginal delivery: >20 × 10⁹/L
- C-section: >50 × 10⁹/L
- Epidural: >70 × 10⁹/L
And don’t forget the baby. Around 30% of infants born to mothers with ITP will have low platelets themselves.
Always check that cord blood count.
The good news? First-line treatments (prednisolone and IVIG) are safe in pregnancy.
What’s your approach when you get that Friday afternoon call about low platelets in a pregnant patient?”
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