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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Clinical features and diagnosis of thrombocytopenic conditions in pregnancy

Clinical features and diagnosis of thrombocytopenic conditions in pregnancy
Disorder Onset during pregnancy Diagnosis
Pseudothrombocytopenia Any time Examine blood smear for platelet clumps, or giant platelets. Repeat platelet count in citrate or heparin anticoagulant. Usually caused by agglutinins dependent upon EDTA, the standard anticoagulant for blood counts.
Gestational thrombocytopenia (GT) Typically late in gestation, frequency increases as term approaches Based on five criteria:
  1. Mild thrombocytopenia (most 100,000 to 150,000/microL, rarely <80,000/microL)
  2. No thrombocytopenia outside of pregnancy
  3. Occurs late in gestation
  4. No fetal/neonatal thrombocytopenia
  5. Postpartum resolution
Immune thrombocytopenia (ITP) Any time Presence of isolated thrombocytopenia with no evidence for alternative etiologies. May be indistinguishable from gestational thrombocytopenia if mild and occurs late during pregnancy. Platelet count may improve after delivery.
Preeclampsia with severe features After 20 weeks gestation Systolic or diastolic hypertension plus proteinuria
HELLP syndrome (hemolysis, elevated liver function tests, and low platelets) After 20 weeks gestation

Diagnostic criteria for preeclampsia are present in 85% of cases.

Hemolysis: Microangiopathic hemolytic anemia with schistocytes, with other signs of hemolysis: increased serum LDH and indirect bilirubin, decreased haptoglobin

Elevated liver function tests (eg, AST, ALT), typically ≥twice normal

Low platelets: Platelet count ≤100,000/microL
Thrombotic thrombocytopenic purpura (TTP) Typically late in gestation, frequency increases as term approaches. May occur after delivery. Thrombocytopenia and microangiopathic hemolytic anemia without an alternative etiology. May be indistinguishable from severe preeclampsia or HELLP syndrome. Severe neurologic abnormalities and acute renal failure support the diagnosis of TTP. Persistent abnormalities ≥3 days after delivery also support the diagnosis of TTP.
Drug-induced immune thrombocytopenia (DITP) (except heparin) Any time Complete history of drug ingestion, including non-prescription drugs and herbal remedies. Focus on drugs taken intermittently, or regularly for more than one week. Thrombocytopenia typically resolves in five to seven days after stopping the drug.
Heparin-induced thrombocytopenia (HIT) Any time

Suspected in patients who have thrombocytopenia (or >50% decrease in platelet count) and who have begun heparin within previous 5 to 10 days.

Thrombocytopenia is typically mild; arterial or venous thrombi are commonly present. ELISA assay for heparin-dependent antibodies is sensitive; measurement of heparin-induced platelet serotonin release is more specific.
Antiphospholipid syndrome (APS) Any time

Requires one clinical and one laboratory criterion:

Clinical:
  1. Adverse pregnancy outcome: ≥3 losses <10 weeks gestation or ≥1 loss ≥10 weeks gestation, <34 week delivery secondary to preeclampsia or placental insufficiency
  2. Arterial or venous thrombosis

Laboratory:

Demonstration of the persistent presence of at least one of the following antiphospholipid antibodies:
  1. Lupus anticoagulant
  2. Anticardiolipin antibody
  3. Anti-β2 glycoprotein-I
Refer to UpToDate for additional details of the clinical features.
EDTA: ethylenediaminetetraacetic acid; LDH: lactate dehydrogenase; AST: aspartate aminotransferase; ALT: alanine aminotransferase.
Courtesy of James N George, MD and Eric J Knudtson, MD.
Graphic 53727 Version 9.0

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