Thrombocytopenia in Pregnancy

Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton pregnancy

Both thrombocytopenia (platelet count < 150 × 10³/µL) and anemia have been associated with postpartum hemorrhage (PPH). However, the impact of thrombocytopenia on PPH risk among women with mild and severe anemia is unknown. We sought to evaluate the association between thrombocytopenia and anemia in increasing risk of PPH. We performed a secondary analysis of a retrospective cohort of pregnant women from 19 hospitals across the United States from 2016 to 2021. Women who had a term singleton pregnancy and hematocrit (Hct) ≤ 33% at delivery were included in the study. The primary outcome was PPH (defined as blood loss ≥ 1000 mL or blood transfusion). We also analyzed the effect of severe anemia (Hct < 28%) on the association between PPH and thrombocytopenia. Chi-squared tests and Fisher's exact tests were used for categorical variables and an independent t-test was used for continuous variables. There were 20,808 women who met our inclusion criteria, of which 1793 (8.6%) had platelet count < 150 × 10³/µL. The prevalence of PPH was 6.4%. Compared with women with normal platelet count, those with thrombocytopenia had 1.3-fold higher odds of PPH [6.8% vs. 4.5%, adjusted OR 1.3 (1.1-1.7)]. Platelet count ≥ 150 × 10³/µL was associated with decreased odds of PPH among patients with hct between 28 and 33% and hct < 28%. In conclusion, anemic women with term singleton pregnancies who delivered with thrombocytopenia had a higher frequency of PPH. Normal platelet count at delivery was protective against PPH in the setting of anemia regardless of severity.

Severe thrombocytopenia in pregnancy: a retrospective study

: Thrombocytopenia is defined as a platelet count less than 150 000/μl and it is the most common hematologic disease after anemia in pregnancy. This study aims to investigate pregnant women with severe thrombocytopenia (platelet count <50 000/μl). In the relevant literature, few studies have addressed severe thrombocytopenia in pregnancy. This is a retrospective study based on the data from a reference center in Ankara, Turkey between January 2016 and December 2017. The study group consisted of 51 pregnant women who had two platelet counts lower than 50 000/μl. Descriptive statistical methods were utilized to analyze the results. The study analyzed the causes of severe thrombocytopenia, maternal and fetal-neonatal outcomes, and the management of the patients. The common causes of severe thrombocytopenia were hypertensive disorders (66.7%), immune thrombocytopenia (13.7%), massive obstetric hemorrhage (7.8%), and disseminated intravascular coagulation (5.9%). The preterm delivery occurred in 58.8% of the patients, and 46 live-births (two twins), six stillbirths, and one pregnancy termination emerged. Postpartum hemorrhage occurred in four (0.08%) patients, and blood transfusion was performed in 15 (29.4%) patients. The platelet transfusion was required to increase the platelet count of 30 (58.8%) patients. The study showed that the incidence of causes in severe thrombocytopenia in pregnancy varied considerably from mild and moderate thrombocytopenia. Despite severe thrombocytopenia, maternal and neonatal bleeding complications were infrequent in the study group.

Persistent organic pollutants and haematological markers in Greenlandic pregnant women: the ACCEPT sub-study

The Arctic populations have high blood concentrations of persistent organic pollutants (POPs). Exposure to POPs was related to adverse health effects e.g. immune, neurological and reproductive systems. This study investigates associations between serum POP levels and haematological markers in Greenlandic pregnant women. This cross-sectional study included 189 women enrolled in 2010–2011 at the Greenlandic West coast by the inclusion criteria ≥18 years of age and had lived for 50% or more of their life in Greenland. The associations between the sum of the POP variables polychlorinated biphenyls (sumPCBs), organochlorine pesticides (sumOCPs), perfluoroalkylated substances (sumPFASs) and 24 haematological markers were analysed using linear regression adjusted for age, pre-pregnancy BMI, parity, gestation week, plasma-cotinine and alcohol intake. It showed a significantly inverse association between several haematological markers (eosinophil, lymphocyte, neutrophil and white blood cells) and sumPCBs, sumOCPs and sumPFASs. In addition, the monocyte, mean corpuscular haemoglobin concentration, plateletcrit and platelet count markers were significantly inversely associated with sumPFASs, but the haematocrit and mean erythrocyte corpuscular volume were positively associated with sumPFASs. In conclusion, exposure to POPs influenced several haematological markers, especially cell count parameters, suggesting immunosuppressive potential of POPs in Greenlandic pregnant women. The data need further investigations.

How to approach thrombocytopenia

Thrombocytopenia is a common hematologic finding with variable clinical expression. A low platelet count may be the initial manifestation of infections such as HIV and hepatitis C virus or it may reflect the activity of life-threatening disorders such as the thrombotic microangiopathies. A correct identification of the causes of thrombocytopenia is crucial for the appropriate management of these patients. In this review, we present a systematic evaluation of adults with thrombocytopenia. The approach is clearly different between outpatients, who are frequently asymptomatic and in whom we can sometimes indulge in sophisticated and relatively lengthy investigations, and the dramatic presentation of acute thrombocytopenia in the emergency department or in the intensive care unit, which requires immediate intervention and for which only a few diagnostic tests are available. A brief discussion of the most common etiologies seen in both settings is provided.