Abstract
The impact of thrombocytopenia varies widely depending on the underlying pathophysiology
driving it. The biggest challenge in managing thrombocytopenia in pregnancy is accurately
identifying the responsible pathophysiology—a task made difficult given the tremendous
overlap in clinical and laboratory abnormalities associated with different thrombocytopenia
processes. The most common etiologies of thrombocytopenia in pregnancy range from
physiology deemed benign to those that are life-threatening to the mother and fetus.
Even in cases in which the responsible etiology is deemed benign, such as gestational
thrombocytopenia, there are still implications for the management of labor and delivery,
a time where hemostatic challenges may prove life-threatening. In most institutions,
a minimum platelet count will be mandated for epidural anesthesia to be deemed a safe
option. The causes of thrombocytopenia can also include diagnoses that are pregnancy-specific
(such as preeclampsia or gestational thrombocytopenia), potentially triggered by pregnancy
(such as thrombotic thrombocytopenic purpura), or unrelated to or predating the pregnancy
(such as liver disease, infections, or immune thrombocytopenia purpura). It is imperative
that the source of thrombocytopenia is identified accurately and expeditiously, as
intervention can range from observation alone to urgent fetal delivery. In this review,
the approach to diagnosis and the pathophysiological mechanisms of the most common
etiologies of thrombocytopenia in pregnancy and associated management issues are presented.
Keywords
pregnancy - thrombocytopenia - microangiopathy - preeclampsia - TTP
