Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
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Case Report

Volume 5, Number 4, December 2016, pages 142-150


Severe Gestational Thrombocytopenia: A Case Report and Brief Review of the Literature

Figure

Figure 1.
Figure 1. Platelet count during second pregnancy.

Table

Table 1. Differential Diagnosis of GT and ITP in Pregnancies With New-Onset Thrombocytopenia
 
FeaturesGestational thrombocytopenia (GT)Immune thrombocytopenia (ITP)
*Diagnosis must be questioned if item was not fulfilled.
Peripheral blood smear examination (PBS)Isolated TCP, abundant normal megakaryocytes, normal platelets of all generations while other cell-lines are normal*Isolated TCP, abundant normal megakaryocytes, normal platelets of all generations while other cell-lines are normal*
DiagnosisExclusion of other causes of TCP [3]Exclusion of other causes of TCP especially secondary ITP [3]
Past historyNegative before pregnancy* (except in previous pregnancy)Mostly positive, but 30% of ITP cases might present for the first time during pregnancy (new-onset).
Timing of diagnosisMight appear at any trimester but mostly during late second or third trimesters [11]Can appear at any trimester but typically in early pregnancy [11].
Platelet count trendsDecrease towards full-term if appeared early [24]Decrease towards full-term in at least 50% of cases [16, 22].
Multifetal pregnancyCommon association [11]No reports of such predilection.
Postpartum recoveryUsually rapid and necessarily back to normal levels*Recovery is usually slower and unlikely to normal levels*
Platelet count levelsUsually > 70 × 109/L but can reach lower levels [9]Variable and can reach very low levels.
Predisposes to obstetric complicationsNone [10]None [23].
Maternal bleeding episodesNone reported even with low platelet counts*Probable. New-onset cases of ITP might have higher rates of bleeding [6].
Neonatal thrombocytopeniaProbable, reported rates (0.1-2%) similar to infants born to non-thrombocytopenic mothers [6, 8] though others reported higher rates [25, 27].Affects (25%) of cases but cannot be predicted and not related to maternal platelet count or antibodies titers [13].
Neonatal bleedingNone [3] even in newborns with low platelet counts.Can occur but uncommon [16] with serious bleeding as ICT only 1-2% [26].
Response to steroids or IVIG treatmentNo treatment is required. In the very few severe cases who received treatment, no response was elicited [18, 19].Response as in non-pregnant cases. Thirty to fifty percent of patients might require treatment [16]. More new-onset cases might require therapy [16].
Recurrence in future pregnanciesProbable, but rate is unknown.Probable, but rate is unknown.