When pregnant, a woman apart from facing various physical and emotional problems faces few unavoidable medical problems. One such medical challenge that she may encounter during her gestation is thrombocytopenia.
So, what is the function of platelets?
Apart from your RBC’s (red blood cells), you have your WBC’s (white blood cells) and thrombocytes (platelets) in your blood. Your RBC’s carry oxygen, your WBC’s help in fighting off an infection and then you have your thrombocytes aka your platelets, which are mainly responsible to arrest bleeding after an injury or insult (by forming a platelet plug).
The normal platelet counts generally is a range from 150,000 – 450,000 μl of blood.
What is thrombocytopenia?
Thrombocytopenia is a condition characterized by dropping of the platelet count (as the name suggests, thrombocytes = platelets, penia = decrease) and can be categorized based on its count as:
What is gestational thrombocytopenia and what are its features?
Gestational thrombocytopenia or low platelet count while pregnant, occurs in approximately 8-10% of pregnancies, and is the second most common hematological disorder after anemia. Like anemia, in the initial stages, it may go unnoticed, so it is vital that you know the signs and symptoms beforehand.
The features of gestational thrombocytopenia include:
- No past history of thrombocytopenia
- Most cases are mild i.e. 100-150,000 μl with no history of maternal bleeding
- Typically, late in gestation, and resolves within days to weeks postpartum
- Not associated with fetal thrombocytopenia
- May recur in subsequent pregnancies
What causes drop in platelet count during pregnancy?
During pregnancy, thrombocytopenia occurs secondary to physiological changes such as:
- Hemodilution: An increase in blood volume (causing blood dilution or hemodilution)
- Placental involvement: Destruction of platelets in the placenta.
- HELLP syndrome: A complication of high blood pressure or pre-eclampsia in late pregnancy, HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) syndrome causes liver damage which further results in low platelet level
- Medicine Induced: Medications such as ibuprofen, paracetamol etc. may hamper platelet production.
- ITP or Immune Thrombocytopenic Purpura: An immune-mediated disorder which leads to a decrease in the platelet count.
How can you diagnose gestational thrombocytopenia?
As it is difficult to initially see the symptoms of thrombocytopenia it may be difficult for it to be diagnosed. The diagnosis is generally based on exclusion. Nonetheless, a complete blood count test during prenatal checkup which shows low platelet cell count is confirmatory!
Note: If there is a history of thrombocytopenia prior to pregnancy, in most cases, it will not be considered as gestational thrombocytopenia.
What are the risks if you have gestational thrombocytopenia?
If you have been diagnosed with gestational thrombocytopenia your doctor will brief you on all the associated risks that may arise during your childbirth. The most common being:
- Increased chance of bleeding during or after childbirth
- Risk is more in case of surgical birth compared to vaginal
- Accidental puncture during anesthesia can cause bleeding or hematoma which might result in paralysis
What is the treatment for low platelet count during pregnancy?
The first course of action would be to find out the underlying cause of thrombocytopenia. Then, based on the underlying medical condition and the platelet count, a treatment plan is decided. In most instances, the treatment is based on the severity of the disease and be categorized under:
- Mild conditions: Usually no medical intervention but may require constant monitoring
- Severe conditions: Usually by managing the underlying condition such as HELLP which is causing platelet drop.
Can diet modification help you manage low platelet count?
Certain food can help in preventing low platelet count naturally. These mainly come under:
- Fruits like pomegranates, oranges etc
- Food rich in Vitamin B12 like fish, chicken etc.
- Folate rich food like green leafy vegetables, beans, spinach, asparagus etc
- Dry fruits such as raisins
- Fresh milk
Is having gestational thromocytopenia harmful to my baby or my health?
Though most cases of thrombocytopenia do not pose a serious threat to the mother or unborn child, it is better to prepare yourself and know the signs and symptoms of the onset of the disease. It goes without saying that you should get your tests done routinely and meet your doctor as per your appointment scheduled. This way you can be diagnosed at an earlier date and get the apt treatment as soon as possible.
Timely detection and treatment of your condition will reduce the chances of complications.
How can gestational thrombocytopenia affect my delivery?
Gestational thrombocytopenia may not alter the course of your pregnancy, but during delivery time, it may be somewhat of a concern.
Having low platelets is of more concern if you opt for a C-section as the blood loss is significantly more in a c-section birth when compared to a normal/vaginal birth.
The uterus, when compared with any other organ in the body, has the largest supply of blood. Hence, when any major vessel is cut during a C-section, it is bound to bleed longer when there is a delay in the stoppage of bleeding/clotting due to reduced platelets.
So, your doctor may speak to you about it and may indicate the need for blood transfusions during the surgery and also for you to make an informed consent.
This article was a brief description of low platelet count during pregnancy and what you can expect. Nonetheless, the best source of information would be your doctor/gynecologist. So, we urge you to please consult your doctor whenever you are in doubt and also build your awareness. Happy pregnancy!