PB0699 - Identification and clinical management of thrombocytopenia in pregnants

Background: Thrombocytopenia is diagnosed in 7%-10% of all pregnancies, being the second most frequent cause of hemopathy during pregnancy. Pregnancy increases the need to obtain a rapid diagnosis of the cause of thrombocytopenia in order to establish appropriate medical care to avoid the complications affecting both the pregnant and the fetus.

Aims: The objective is to evaluate the causes of thrombocytopenia in pregnant women and its clinical management and follow-up during pregnancy and delivery.

Methods: Observational, descriptive and retrospective study of pregnants with thrombocytopenia criteria managed in the Hemostasis Unit between January 2019 and October 2022.

Results: Data from 93 pregnants with thrombocytopenia with a median age of 37 years (24-48; RIQ= 32-40) were included. Median platelet count at baseline was 120 x 109/L (10-321; RIQ= 103-150) and one woman (1.1%) had bleeding at diagnosis. Six pregnants (6.5%) were excluded because of pseudothrombocytopenia. Most frequent cause was gestational thrombocytopenia (GT) in 75 women (80.6%), followed by hypertensive syndromes in two (2.2%). The causes of thrombocytopenia not associated with pregnancy included 6 pregnants (6.5%) with idiopathic thrombocytopenic purpura (ITP), 3 (3.4%) with positive serology for HBV, HCV or HIV and one with primary antiphospholipid syndrome.
Five (5.4%) had hemorrhagic symptoms, of whom four (4.3%) received treatment. Two women with ITP received glucocorticoids and one pregnant with ITP received glucocorticoids and gamma globulins.
Minimum platelet count of patients with ITP was lower (35 x 109/L vs. 93 x 109/L) (p=0.02) and they had more hemorrhages than pregnant with TG (33.3% vs. 4%) (p= 0.004).

Conclusion(s): Gestational thrombocytopenia is the most frequent cause of thrombocytopenia during pregnancy. GT is not associated with serious complications during pregnancy or delivery and does not usually require treatment whereas other causes such as ITP, history of HBV, HCV or HIV infection, AFS or hypertensive syndromes require close monitoring during pregnancy and delivery.