Differential diagnosis of thrombocytopaenia in pregnancy

Czech version

Authors: J. Gumulec ¹; O. Šimetka ²; M. Procházka ³; J. Ullrychová ⁴
Authors‘ workplace: Ústav klinické hematologie FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec ¹; Porodnicko-gynekologická klinika FN Ostrava, přednosta prim. MUDr. Ondřej Šimetka ²; Porodnicko-gynekologická klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Radovan Pilka, Ph. D. ³; Oddělení laboratoří a transfuzní služby Nemocnice Děčín, o. z., přednostka prim. MUDr. Jana Ullrychová ⁴
Published in: Vnitř Lék 2010; 56(Supplementum 1): 91-97
Category: 16th Parizek's Days, Ostrava-Poruba, March 25th –26th 2010

Overview

The recognition of thrombocytopenia is quite common in pregnancy, occurring in nearly 10 % of pregnant women. An unusual aspect of most of these events is that the majority are physiological. This, so called gestational thrombocytopenia must be differentiated from the less common, but clinically significant occurrence of a pathological mechanism for the platelet count decline. Such events are commonly associated with evident clinical features and are potentially serious issues in the maintenance of pregnancy and the health of the mother. In these cases the accurate diagnosis must be made very quickly. Moreover, uterine evacuation is indicated in the therapy of some disorders, while in others alternative interventions may allow the pregnancy to be carried to term. Though obstetricians manage most of these cases, more complex thrombocytopenic disorders are often referred for hematologic consultation. Therefore, the consulting hematologist must have a working knowledge of the differential diagnosis and therapy of pregnancy-associated thrombocytopenia. The goal of this article is to review the differential diagnosis, pathophysiology and management of these disorders.

Key words:
thrombocytopenia – pregnancy – immune thrombocytopenia – gestational thrombocytopenia – preeclampsia – HELLP syndrome – thrombotic thrombocytopenic purpura – hemolytic-uremic syndrome – acute fatty liver of pregnancy – disseminated intravascular coagulation

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