Causes of thrombocytopenia in pregnancy other than gestational thrombocytopenia

Condition	Associated features
Pregnancy-associated conditions*
Preeclampsia	By definition, preeclampsia occurs after 20 weeks of gestation. Hypertension is present. Preeclampsia with severe features is a subset of preeclampsia; refer to UpToDate for diagnostic criteria.
HELLP syndrome	Microangiopathic hemolysis (with schistocytes), platelet count <100,000/microL, increased hepatic transaminases.
DIC	Coagulation abnormalities, anemia. If due to infection, fever, leukocytosis, and/or leukopenia may be present.
Acute fatty liver of pregnancy	Increased hepatic transaminases.
Hereditary TTP or hereditary C-TMA	Microangiopathic hemolysis (with schistocytes). In hereditary TTP, there may be neurologic or psychiatric findings. In C-TMI, there is almost always AKI.
Conditions unrelated to the pregnancy^¶
Immune thrombocytopenia (ITP)	Generally asymptomatic except for petechiae and/or bleeding manifestations.
Hereditary thrombocytopenia	Abnormal platelet morphology may be present. Some hereditary thrombocytopenia syndromes are associated with other findings such as radial (thumb) anomalies.
Infection (viral, bacterial)	Fever, rash, localizing symptoms. Leukocytosis or leukopenia may be present.
SLE or APS	SLE may have other disease manifestations and/or other cytopenias; APS may have a prolonged baseline aPTT or PT; prolonged aPTT is more common.
Drug-induced thrombocytopenia	Exposure to implicated medications or quinine.
von Willebrand disease	History of increased bleeding or bruising; the aPTT may be prolonged in some cases.
HIV infection	Leukopenia and/or lymphadenopathy may be present.
HCV infection	Increased hepatic transaminases.
Hypersplenism	Underlying liver disease; splenomegaly on examination.
Deficiency of vitamin B12 or folate	Macrocytic anemia. In vitamin B12 deficiency, there may be neurologic or psychiatric findings.
Acquired TTP or HUS	Microangiopathic hemolysis (with schistocytes). In TTP, there may be neurologic or psychiatric abnormalities. In HUS, AKI is typically present and there may be a preceding diarrheal illness.

Refer to the companion table in UpToDate on the likelihood of GT in individuals with asymptomatic thrombocytopenia in pregnancy. Refer to UpToDate for our approach to distinguishing among these causes of thrombocytopenia in a pregnant woman.

HELLP: hemolysis, elevated liver function tests, and low platelets; DIC: disseminated intravascular coagulation; TTP: thrombotic thrombocytopenic purpura; C-TMA: complement-mediated thrombotic microangiopathy; AKI: acute kidney injury; SLE: systemic lupus erythematosus; APS: antiphospholipid antibody syndrome; aPTT: activated partial thromboplastin time; PT: prothrombin time; HCV: hepatitis C virus; HUS: hemolytic uremic syndrome; GT: gestational thrombocytopenia.
* In general, the pregnancy-associated conditions are more likely to present beyond 20 weeks of gestation, around the time of delivery, or postpartum.
¶ Conditions are listed in approximate order of prevalence. In general, there may be evidence of the condition in pre-pregnancy laboratory testing, if available.

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Causes of thrombocytopenia in pregnancy other than gestational thrombocytopenia