Thrombocytopenia in Pregnancy Overview
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Questions and Answers

What is the approximate prevalence of thrombocytopenia in pregnancies?

  • 5%
  • 15%
  • 20%
  • 10% (correct)

Which of the following is NOT a common cause of thrombocytopenia in pregnancy?

  • Preeclampsia
  • Immune thrombocytopenia
  • Gestational thrombocytopenia
  • Blood disorders unrelated to pregnancy (correct)

What is the significance of multidisciplinary collaboration in managing thrombocytopenia during pregnancy?

  • To decide on what medication to prescribe
  • To manage postpartum complications solely
  • To ensure accurate identification of the cause and optimal treatment (correct)
  • To focus primarily on fetal outcomes

Which condition is a diagnosis of exclusion related to thrombocytopenia in pregnancy?

<p>Gestational thrombocytopenia (B)</p> Signup and view all the answers

What is the potential consequence of maternal thrombocytopenia that requires intervention?

<p>Hemorrhage during labor and delivery (C)</p> Signup and view all the answers

Why is predicting the course of thrombocytopenia challenging during pregnancy?

<p>Due to overlap of symptoms with normal pregnancy (A)</p> Signup and view all the answers

What is crucial for optimizing treatment and management of thrombocytopenia in pregnant patients?

<p>Shared decision-making with the patient (A)</p> Signup and view all the answers

What is the role of a complete blood count (CBC) in diagnosing gestational thrombocytopenia?

<p>It confirms recovery to a normal platelet count postpartum (B)</p> Signup and view all the answers

What is a common potential cause of gestational thrombocytopenia (GT)?

<p>Insufficient thrombopoietin response (C)</p> Signup and view all the answers

At which week of pregnancy does the decrease in ADAMTS13 levels start to occur?

<p>Week 12 (D)</p> Signup and view all the answers

Which of the following is NOT a feature associated with gestational thrombocytopenia (GT)?

<p>Direct correlation with platelet count (D)</p> Signup and view all the answers

What distinguishes gestational thrombocytopenia from preeclampsia in terms of TPO levels?

<p>GT has higher TPO levels than pregnancy with normal platelet counts (B)</p> Signup and view all the answers

Which of the following hypotheses does NOT explain gestational thrombocytopenia (GT)?

<p>Elevated platelet count (A)</p> Signup and view all the answers

How does the relative proportion of causes of thrombocytopenia vary during pregnancy?

<p>It changes based on trimester and severity (C)</p> Signup and view all the answers

What is the TPO level in women with gestational thrombocytopenia (GT)?

<p>187 pg/mL (B)</p> Signup and view all the answers

What is the focus of the review mentioned regarding the common thrombocytopenic processes?

<p>Gestational thrombocytopenia (GT), preeclampsia, and immune thrombocytopenia (ITP) (B)</p> Signup and view all the answers

What is preeclampsia characterized by?

<p>High blood pressure and proteinuria (C)</p> Signup and view all the answers

Which factor is primarily implicated in the pathogenesis of preeclampsia?

<p>Increased levels of sFlt-1 (C)</p> Signup and view all the answers

What is the preferred treatment option for significant thrombocytopenia in late pregnancy?

<p>Romiplostim (D)</p> Signup and view all the answers

How does aspirin benefit pregnant women at risk of preeclampsia?

<p>It prevents or delays its onset. (A)</p> Signup and view all the answers

What is the reported incidence of preeclampsia in pregnancies?

<p>3% to 4% (D)</p> Signup and view all the answers

What is the primary corticosteroid recommended for use in pregnant patients with ITP?

<p>Prednisone (B)</p> Signup and view all the answers

What was the median platelet count reached by patients treated in the retrospective analysis?

<p>$94 × 10^9/L$ (A)</p> Signup and view all the answers

Which of the following is a common symptom of preeclampsia?

<p>Presence of schistocytes in blood (B)</p> Signup and view all the answers

What should be reviewed when taking a thorough history for preeclampsia?

<p>Remote CBCs for baseline platelet count (D)</p> Signup and view all the answers

What maternal side effect can be associated with corticosteroid use during pregnancy?

<p>Gestational diabetes (B)</p> Signup and view all the answers

What role do tyrosine kinase-1 and sFlt-1 play in pregnancy-related issues?

<p>They sequester proangiogenic molecules. (B)</p> Signup and view all the answers

Which TPO-RA was reported to be used in the retrospective analysis?

<p>Romiplostim (A), Eltrombopag (C)</p> Signup and view all the answers

What is a critical consideration when starting prednisone treatment in pregnant ITP patients?

<p>Timing of administration (C)</p> Signup and view all the answers

What percentage of neonates with available platelet counts had thrombocytopenia in the analysis?

<p>43% (D)</p> Signup and view all the answers

What is the recommended duration for a trial of prednisone to assess response in ITP management?

<p>5 days (B)</p> Signup and view all the answers

Which of the following is NOT associated with TPO-RAs according to the analysis?

<p>Birth defects (A), Fetal losses (C), Thromboembolic events (D)</p> Signup and view all the answers

What is one potential outcome of VWF polymorphisms under high shear flow conditions?

<p>Enhanced platelet adhesion. (C)</p> Signup and view all the answers

What is the general recommendation for managing women with a diagnosis of GT?

<p>Regular observation is appropriate. (C)</p> Signup and view all the answers

Why might there be variability in accepted platelet targets for epidural anesthesia across institutions?

<p>No randomized data defining a safe platelet threshold exist. (A)</p> Signup and view all the answers

What has been observed in retrospective studies regarding regional anesthesia in women with low platelet counts?

<p>No complications at the threshold of 70 × 10^9/L. (A)</p> Signup and view all the answers

What percentage of pregnancies in a study were diagnosed with GT?

<p>12% (D)</p> Signup and view all the answers

Which of the following disorders is NOT mentioned as being associated with the management issues in GT?

<p>Gestational diabetes. (C)</p> Signup and view all the answers

What is emphasized as important for developing management guidelines for GT?

<p>Regular dialogue between multidisciplinary providers. (C)</p> Signup and view all the answers

What issue may arise from enforcing an arbitrary target for platelets in the context of epidural anesthesia?

<p>Unnecessary treatment or denial of anesthesia. (A)</p> Signup and view all the answers

Flashcards

Thrombocytopenia in Pregnancy

A common hematologic condition during pregnancy, affecting roughly 10% of pregnancies, encompassing several causes, from mild to severe.

Gestational Thrombocytopenia (GT)

Most common cause of thrombocytopenia in pregnancy (20%). Platelet count falls below 100,000/mm3, resolving postpartum.

Preeclampsia

Pregnancy complication (3-4%) characterized by high blood pressure, significant protein in urine, and organ dysfunction after 20 weeks of gestation.

Immune Thrombocytopenia (ITP)

Rare pregnancy-related thrombocytopenia (1%); caused by anti-platelet antibodies, potentially present/developing during pregnancy.

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Platelet Count

Measurement of platelets in the blood; crucial for diagnosing and managing thrombocytopenia.

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Multidisciplinary Approach

Collaboration (hematology, obstetrics, anesthesia) essential for effectively managing thrombocytopenia in pregnancy.

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Differential Diagnosis

Distinguishing among various possible causes of thrombocytopenia during pregnancy.

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Thrombotic Microangiopathy (TMA)

Pathology involving blood clots in small blood vessels in preeclampsia, causing blood cell damage.

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sFlt-1

Antiangiogenic factor secreted by placenta; elevated levels in preeclampsia, contributing to the disease process.

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Maternal Hypertension

High blood pressure in pregnant women.

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Proteinuria

Presence of abnormally high levels of protein in the urine.

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End-Organ Dysfunction

Damage to vital organs due to preeclampsia or other complications.

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Haemodilution

Reduction of red blood cell concentration in the blood, a possible factor in gestational thrombocytopenia.

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von Willebrand Factor (VWF)

Protein in blood clotting. Increased levels may relate to GT.

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Thrombopoietin (TPO)

Protein causing platelet production.

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ADAMTS13

Enzyme destroying von Willebrand factor.

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Diagnosis of exclusion

Ruling out other possibilities before confirming a diagnosis, particularly important for GT.

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Management of maternal risk

Prioritizing strategies to reduce maternal bleeding risk, especially during labor and delivery.

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Monitoring platelet counts

Regularly checking platelet count during pregnancy and postpartum, to reduce maternal and fetal risks.

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Case 1

27-year-old in 34 weeks of pregnancy with a platelet count of 108 × 109/L, previous similar history and requires ongoing monitoring.

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Study Notes

Thrombocytopenia in Pregnancy

  • Thrombocytopenia is a common hematologic abnormality in pregnancy, affecting approximately 10% of pregnancies.
  • It encompasses a wide range of causes, from benign conditions requiring no intervention to life-threatening disorders necessitating prompt diagnosis and treatment.
  • Although thrombocytopenia may be an inherited condition or pre-existing, most commonly it is a new diagnosis during pregnancy.
  • Differentiation between normal pregnancy and potential causes of thrombocytopenia can be challenging due to significant overlap in clinical features and laboratory data.
  • Effective management requires multidisciplinary collaboration among hematology, obstetrics, and anesthesia, and shared decision-making with the patient, considering potential fetal impact of the maternal thrombocytopenia and any therapeutic intervention.
  • This review highlights the subtle differences in presentation, physical examination, clinical course, and laboratory abnormalities to facilitate a focused differential diagnosis.

Gestational Thrombocytopenia (GT)

  • GT is the most frequent cause of thrombocytopenia in pregnancy, affecting approximately 20% of pregnancies.
  • Occurs due to platelet counts below 100,000/mm3 during pregnancy, resolving postpartum, with a complete blood count (CBC) confirming recovery.
  • The exact mechanism of GT is unknown, but potential hypotheses include hemodilution, increased von Willebrand Factor (VWF), insufficient thrombopoietin (TPO) response, or reduced ADAMTS13 activity levels.
  • GT is a diagnosis of exclusion requiring ruling out other potential causes such as preeclamsia, immune thrombocytopenia (ITP), and other complications.
  • GT management involves managing maternal risk of bleeding, particularly during labor and delivery.

Preeclampsia

  • Preeclampsia affects 3% to 4% of all pregnancies and is characterized by maternal hypertension (blood pressure ≥140/90 mm Hg) with proteinuria and/or end-organ dysfunction after 20 weeks of gestation.
  • Preeclampsia is a thrombotic microangiopathy (TMA) characterized by schistocytes on the peripheral blood film.
  • The pathogenesis involves abnormal placentation and angiogenic imbalance, with excess secretion of the placentally derived antiangiogenic factor, soluble fms-like tyrosine kinase-1 (sFlt-1).
  • Increased sFlt-1/placental growth factor ratios are observed in preeclampsia, both at diagnosis and weeks before the onset of clinical symptoms, suggesting a causal role.

Immune Thrombocytopenia (ITP)

  • Presents infrequently during pregnancy, accounting for only 1% of pregnancy-related cases of thrombocytopenia.
  • Characterized by the presence of anti-platelet antibodies, leading to platelet destruction.
  • The condition may persist or arise during pregnancy.

Management of Thrombocytopenia in Pregnancy

  • A complete history including family, prior CBCs, prior pregnancies, and potential autoimmune conditions, drug exposure, and fevers is crucial for diagnosis and management.
  • A critical component of management involves careful monitoring of platelet counts throughout pregnancy and the postpartum period, focusing on minimizing the risk of maternal and fetal complications.
  • The differential diagnosis guided by the onset and severity of thrombocytopenia guides suitable laboratory data and physical examinations.

Case 1: A 27-year-old female at 34 weeks of gestation with platelet count of 108 × 109/L.

  • Patient feels well, but previous pregnancies included thrombocytopenia.
  • Requires further investigation and careful monitoring throughout the pregnancy.

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Description

This quiz explores thrombocytopenia, a common hematologic issue in pregnancy that affects about 10% of expectant mothers. It covers the causes, implications, and management strategies, emphasizing the importance of multidisciplinary approaches in treatment. Learn about the challenges in differentiating normal pregnancy changes from serious conditions related to thrombocytopenia.

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