Approach to a pregnant woman beyond 20 weeks gestation with a platelet count <100,000/microL

Input from the treating obstetrician and hematologist is important and may identify the need for additional testing. Platelet transfusions are indicated for patients with active bleeding, and anticoagulation is indicated for patients with thrombosis. Early involvement of the appropriate consulting specialist is advised. The threshold platelet count of 100,000/microL was chosen to exclude women with gestational thrombocytopenia. Refer to UpToDate topics on thrombocytopenia in pregnancy and specific conditions for additional possible causes of thrombocytopenia and information about management.

BUN: blood urea nitrogen; CBC: complete blood count; PT: prothrombin time; aPTT: activated partial thromboplastin time; MAHA: microangiopathic hemolytic anemia; AKI: acute kidney injury; DIC: disseminated intravascular coagulation; ITP: immune thrombocytopenia; TTP: thrombotic thrombocytopenic purpura; C-TMA: complement-mediated thrombotic microangiopathy; HELLP: hemolysis, elevated liver function tests, and low platelets; LFTs: liver function tests; IVIG: intravenous immune globulin; PEX: plasma exchange.
* Severity of bleeding and source must be evaluated.
¶ Gestational thrombocytopenia is extremely unlikely if the platelet count is <100,000/microL.
Δ Genetic testing for complement mutations may be appropriate for some patients. Refer to UpToDate for details.

Graphic 111837 Version 4.0

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Approach to a pregnant woman beyond 20 weeks gestation with a platelet count <100,000/microL