Samwel Mikaye: Thrombocytopenia in Pregnancy
Samwel Mikaye, CEO of SaMik Medical Center, shared on LinkedIn:
“Thrombocytopenia in Pregnancy
Definition
Platelet count <150,000/µL during pregnancy.
Causes (in order of frequency)
1. Gestational thrombocytopenia (≈75%)
• Mild: 100,000–150,000
• Occurs in late pregnancy
• Asymptomatic
• No fetal risk
• Resolves after delivery
2. Immune thrombocytopenic purpura (ITP)
• Platelets often <100,000
• May occur before or early in pregnancy
• History of thrombocytopenia outside pregnancy
• Risk of neonatal thrombocytopenia
3. Hypertensive disorders
• Preeclampsia
• HELLP syndrome
• Associated with:
• Elevated liver enzymes
• Hemolysis
• Severe maternal risk
4. Other causes
• Acute fatty liver of pregnancy
• Thrombotic thrombocytopenic purpura (TTP)
• Hemolytic uremic syndrome (HUS)
• DIC
• Infections (HIV, malaria)
• Drug-induced (heparin)
Clinical Features
• Often asymptomatic
• Easy bruising, petechiae
• Bleeding gums (severe cases)
Investigations
• Full blood count
• Peripheral blood smear
• Liver function tests
• Blood pressure + urine protein
• Coagulation profile (if bleeding)
Management
Gestational thrombocytopenia
– Reassurance
– No treatment
– Monitor platelet count
ITP
• Treat if:
• Platelets <30,000
• Bleeding
• Near delivery with low counts
• Treatment:
• Corticosteroids
• IV immunoglobulin (IVIG)
Preeclampsia / HELLP
• Stabilize mother
• Control BP
• Definitive treatment: delivery
Platelet count & delivery
• >50,000 → Safe for vaginal delivery
• >80,000–100,000 → Regional anesthesia
• <20,000 → High bleeding risk
• Most common cause: Gestational thrombocytopenia
• Early pregnancy + low platelets → think ITP
• Low platelets + hypertension + ↑LFTs → HELLP”
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