Approach to evaluation and management of platelet count <100,000/microL beyond 20 weeks gestation

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 individuals with gestational thrombocytopenia. Refer to UpToDate topics on thrombocytopenia in pregnancy and specific conditions for additional possible causes of thrombocytopenia and information about management.

AKI: acute kidney injury; aPTT: activated partial thromboplastin time; BUN: blood urea nitrogen; CBC: complete blood count; C-TMA: complement-mediated thrombotic microangiopathy; DIC: disseminated intravascular coagulation; HELLP: hemolysis, elevated liver function tests, and low platelets; ITP: immune thrombocytopenia; IVIG: intravenous immune globulin; LFTs: liver function tests; MAHA: microangiopathic hemolytic anemia; PT: prothrombin time; TPE: therapeutic plasma exchange; TTP: thrombotic thrombocytopenic purpura.

* 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.

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Approach to evaluation and management of platelet count <100,000/microL beyond 20 weeks gestation