From the Guidelines
A platelet count below 50,000 per microliter is considered potentially dangerous during pregnancy, posing significant risks including excessive bleeding during delivery, particularly with cesarean sections, and may limit options for epidural anesthesia. During pregnancy, normal platelet counts typically range from 150,000 to 450,000 per microliter. When counts fall below 100,000, this is classified as thrombocytopenia and requires medical attention. Severe thrombocytopenia (below 50,000) is of particular concern, as it may indicate more serious conditions like preeclampsia, HELLP syndrome, or immune thrombocytopenic purpura (ITP) 1.
Some key points to consider in the management of low platelet counts during pregnancy include:
- Platelet counts should generally be greater than 50,000/mL for cesarean delivery, as recommended by the American Association for the Study of Liver Diseases 1.
- Treatment depends on the cause and severity, ranging from monitoring for mild cases to medications like corticosteroids, intravenous immunoglobulin, or even platelet transfusions for severe cases 1.
- Pregnant women with low platelet counts should attend all prenatal appointments and immediately report any unusual bleeding or bruising to their healthcare provider.
It's worth noting that the most recent and highest quality study, published in 2021, provides guidance on the management of reproductive health and liver disease, including the recommendation for platelet counts during cesarean delivery 1. This study takes precedence over earlier studies, such as those published in 1996 1, in informing clinical decision-making.
From the Research
Definition of Dangerous Platelet Level in Pregnancy
A dangerous platelet level in pregnancy is generally considered to be below 100,000 per cubic millimeter, as stated in the study by 2. However, the study by 3 suggests that thrombocytopenia of < 100,000/microliters is clinically a benign phenomenon that can recur in subsequent pregnancies and is not accompanied by neonatal thrombocytopenia.
Key Findings
- Platelet counts of less than 150,000 per cubic millimeter during uncomplicated pregnancies are described as gestational thrombocytopenia if no alternative cause is identified, as reported in the study by 2.
- The occurrence of thrombocytopenia in 5% of pregnant women at delivery, described as gestational thrombocytopenia, is well documented, as stated in the study by 4.
- Thrombocytopenia which need to be investigated are the following: thrombocytopenia known before pregnancy, thrombocytopenia occurring during the 1st and 2nd trimester, platelet count <75 G/l in the 3rd trimester or thrombocytopenia in case of pregnancy with complications, as suggested in the study by 5.
Platelet Count Ranges
- Normal platelet count range: 150,000-450,000 per cubic millimeter, as implied by the study by 2.
- Gestational thrombocytopenia: platelet count < 150,000 per cubic millimeter, as reported in the study by 2.
- Severe thrombocytopenia: platelet count < 50,000 per cubic millimeter, as stated in the study by 6.
- Danger zone: platelet count < 100,000 per cubic millimeter, as suggested in the study by 2 and 3.
Management and Outcome
- No treatment is required in case of gestational thrombocytopenia, as stated in the study by 5.
- Investigations have to be discussed in function of history and clinical examination, gestational age, and severity of thrombocytopenia, as suggested in the study by 5.
- Severe neonatal thrombocytopenia occurs more frequently than previously reported, and often multiple transfusions and IVIG are required to maintain a platelet count above 50 × 10^9/l, as reported in the study by 6.