Can abortion cause thrombocytopenia (low platelet count)?

From the Guidelines

Abortion itself does not typically cause thrombocytopenia (low platelet count). Thrombocytopenia during pregnancy or following abortion is usually related to underlying conditions rather than the abortion procedure itself. Some women may have pre-existing thrombocytopenia that continues after an abortion, or may develop it due to complications such as infection, severe bleeding, or disseminated intravascular coagulation (DIC) in rare cases of septic abortion. If a patient experiences unusual bleeding, bruising, or petechiae (small red or purple spots on the skin) after an abortion, they should seek immediate medical attention. Blood tests to check platelet counts can be performed if thrombocytopenia is suspected. The normal platelet count range is 150,000-450,000 platelets per microliter of blood, with thrombocytopenia diagnosed when counts fall below 150,000. Treatment would depend on the underlying cause and severity rather than the abortion itself. Physiologically, platelets are produced in bone marrow and play a crucial role in blood clotting, so any significant reduction can increase bleeding risk.

Key Points to Consider

• The relationship between abortion and thrombocytopenia is not directly causal, but rather associated with underlying conditions or complications 1.
• The management of bleeding following major trauma, including situations that might arise from abortion complications, suggests maintaining a platelet count of at least 50 × 10^9/l to prevent or control bleeding associated with deficiencies in platelet number or function 1.
• For patients undergoing major elective nonneuraxial surgery with a platelet count less than 50 × 10^9 cells/L, prophylactic platelet transfusion is suggested, although the quality of evidence is very low and the strength of recommendation is weak 1.
• It's crucial to monitor for signs of thrombocytopenia and to perform blood tests if suspected, given the potential for increased bleeding risk.

Clinical Recommendations

• Monitor patients post-abortion for signs of thrombocytopenia, such as unusual bleeding, bruising, or petechiae.
• Perform blood tests to check platelet counts if thrombocytopenia is suspected.
• Treatment should be based on the underlying cause and severity of thrombocytopenia, rather than the abortion procedure itself.
• Consider prophylactic platelet transfusion for patients with severe thrombocytopenia undergoing surgical procedures, based on current guidelines and the clinical context 1.

From the Research

Abortion and Low Platelet Count

• Abortion has been associated with thrombocytopenia (low platelet count) in some studies 2, 3, 4.
• A study published in 1997 found that a woman with a history of spontaneous abortion developed thrombocytopenia, hemolytic anemia, and liver dysfunction, which were compatible with HELLP syndrome 2.
• Another study published in 1996 found that women with essential thrombocythemia (a condition characterized by an elevated platelet count) had a higher risk of spontaneous abortion, and that a decline in platelet count was associated with a successful pregnancy in 93% of cases 5.
• A study published in 1976 found that patients with septic abortion had increased levels of soluble fibrin monomer complexes, which are associated with hypercoagulability, and that heparin treatment resulted in a decrease in these levels 3.
• A study published in 1987 found that essential thrombocythemia was associated with recurrent abortions and fetal growth retardation, and suggested that antiplatelet agents may be useful in preventing these complications 4.
• A study published in 1990 found that women with habitual spontaneous abortion had activated platelets, which may contribute to the formation of thromboplastin and increase the risk of thrombosis 6.

Mechanisms and Associations

• The exact mechanisms by which abortion may cause low platelet count are not fully understood, but may involve hypercoagulability, thrombosis, and activation of platelets 3, 6.
• Essential thrombocythemia, a condition characterized by an elevated platelet count, may be associated with an increased risk of spontaneous abortion and fetal growth retardation 5, 4.
• HELLP syndrome, a condition characterized by hemolysis, elevated liver enzymes, and low platelet count, may be associated with abortion and anti-phospholipid antibody syndrome 2.