Clin Exp Pediatr. Although gestational thrombocytopenia has been recognized for more than 25 years,1 the course of platelet counts throughout pregnancy and the potential severity of gestational thrombocytopenia have not been defined.4,79 Our data showed that among the women who had uncomplicated pregnancies, the decline in platelet counts began in the first trimester and continued throughout pregnancy, with the nadir occurring at the time of delivery, when 9.9% of the women had platelet counts of less than 150,000 per cubic millimeter. In women who have a platelet count of less than 100,000 per cubic millimeter, a cause other than pregnancy or its complications should be considered. If still worried, I suggest you repeat the blood test for platelets again in 2 weeks. Am Fam Physician. The mean platelet count in the nonpregnant women was 273,000 per cubic millimeter. 39 Thrombocytopenia defined as a platelet count less than 150 10 9 /L complicates approximately 8-10% of pregnancies. 146 - 429. What are platelets and why are they important? This is thought to do with the release of epinephrine, or adrenaline. Figs. Less commonly, blurred vision or headache. What does it mean if your MPV blood test results are high? Centers for Disease Control and Prevention. official website and that any information you provide is encrypted Receive automatic alerts about NHLBI related news and highlights from across the Institute. Paraneoplastic thrombocytosis: the secrets of tumor self-promotion. It is a type of preeclampsia that causes elevated liver enzymes and low platelet count. However, the frequencies of the pregnancy-related complications among these women were similar to U.S. population estimates.2229 Therefore, our data may accurately reflect the platelet counts in women with these pregnancy-related complications. Curtin LR, Mohadjer LK, Dohrmann SM, et al. Haram K, Svendsen E, Abildgaard U. A high test result means that your platelets are larger than what's considered normal. HELLP syndrome is a rare pregnancy complication. Dhaliwal G, Cornett PA, Tierney LM. Many women who have HELLP syndrome need to give birth early to prevent health complications. Age, with risk increasing for women over 25. ACOG practice bulletin no. But it also can develop in the first week after childbirth (postpartum preeclampsia). We offer women's health services, obstetrics and gynecology throughout Northeast Ohio and beyond. J Clin Med Res. We recorded each womans platelet count, race or ethnic group, and age. J Clin Pathol 1975;28:812-3. Platelet counts of less than 80,000 per cubic millimeter for which an alternative cause was not identified occurred in only 5 women (0.1%), none of whom had a platelet count below 62,000 per cubic millimeter. Boehlen F, Hohlfeld P, Extermann P, Perneger TV, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold. High platelet levels caused by primary thrombocytosis, also known as thrombocythemia, can be dangerous in pregnancy and can result in serious maternal and fetal complications. 2019;69(684):e462-e469. When determining whether or not a high platelet count is something to worry about, healthcare providers may look for symptoms like bruising, bleeding, as well as signs of infection or another underlying condition. Among all 15,723 deliveries that occurred at Oklahoma University Medical Center (OUMC) between January 1, 2011, and August 19, 2014, a total of 7351 women who had a platelet count measurement at the time of delivery and at least one platelet count measurement during their pregnancy were selected for inclusion in our study. The mean platelet counts in these women decreased significantly throughout pregnancy (P<0.001) and were lower in all three trimesters and at the time of delivery than the mean platelet counts in the women who had uncomplicated pregnancies (P<0.04 for all comparisons). A full-term pregnancy typically lasts for 40 weeks. 2B). A person with thrombocytopenia has a platelet count of fewer than 150,000 platelets per L. Pregnancy can cause your platelet count to be slightly lower than normal. A high platelet count is not always a serious concern. Loustau V, Debouverie O, Canoui-Poitrine F, et al. Elevated platelets levels during pregnancy generally do not suggest a clinical problem since it is usually a reactive response to the pregnancy. Platelet counts were measured with standard electronic equipment maintained in laboratories certified by the Clinical Laboratory Improvement Amendments program and were categorized according to the following time periods: first trimester of pregnancy, 0 to 13 weeks of gestation; second trimester, 14 to 27 weeks; third trimester, 28 to 42 weeks (excluding the time within 48 hours before delivery); delivery; and postpartum period (defined as 4 to 12 weeks after delivery). Based on the research I did, they could choose to put you on steroids to increase platelet production or give you a platelet infusion. This stratified analysis accounted for any differences in platelet counts on the basis of race or ethnic group or age between the nonpregnant women from NHANES and the pregnant women. Pregnancy-related complications, such as pre-eclampsia, may also cause thrombocytopenia.4,810 Therefore, it may be hypothesized that platelet counts in women who have pregnancy-related complications are lower than platelet counts in women who have uncomplicated pregnancies. Essential thrombocythemia. In our primary analyses, we included women who had a singleton pregnancy, whose duration of gestation at the time of delivery was recorded, and who had a platelet count measurement at the time of delivery and at least one additional platelet count measurement during their pregnancy. Sainio S, Kekomki R, Riikonen S, Teramo K. Maternal thrombocytopenia at term: a population-based study. Accessed 7/16/2021. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Clinicians can identify a high platelet count through routine blood tests. The total white cell count will frequently be elevated in pregnancy due to increased numbers of neutrophils. Pregnancy-related complications that were recorded as such were hypertension or diabetes before or during pregnancy, preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, preterm birth (defined as birth before 37 weeks of gestation), stillbirth, and placental abnormalities (e.g., placental abruption, placenta previa, or placenta accreta). Platelet counts differ by sex, ethnicity, and age in the United States. HELLP syndrome may occur before the third trimester but it is rare. The mean platelet count was 251,000 per cubic millimeter in the first trimester of pregnancy (mean gestation, 8.7 weeks), 230,000 per cubic millimeter in the second trimester (mean gestation, 22.0 weeks), 225,000 per cubic millimeter in the third trimester (mean gestation, 32.1 weeks), 217,000 per cubic millimeter at the time of delivery (mean gestation, 39.0 weeks), and 264,000 per cubic millimeter during the postpartum period (mean time after delivery, 7.1 weeks). If you have HELLP syndrome, you may experience pain in the upper part of your belly, blurred vision, fatigue or swelling. Pediatr Hematol Oncol. Panel B shows the mean platelet counts of the women who had uncomplicated pregnancies, the women who had pregnancy-related complications, and the women who had preexisting disorders that were associated with thrombocytopenia. Other risk factors for HELLP syndrome include: Women may notice HELLP syndrome symptoms while they are pregnant or shortly after childbirth. Shown are the distribution of the mean platelet counts of the nonpregnant women and the distribution of the mean platelet counts during the first trimester (mean gestation, 8.7 weeks) and at the time of delivery in the women who had uncomplicated pregnancies. Verywell Health. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. While some stress is unavoidable during pregnancy, avoiding high-stress situations or learning to manage your stress is a good idea. Among the 12 women with uncomplicated pregnancies who had a platelet count below 80,000 per cubic millimeter, only 5 (0.1%, among whom the range of platelet counts was 62,000 to 78,000 per cubic millimeter; median, 65,000) were identified by medical record review as having no alternative cause for the thrombocytopenia. There are many types of anemia, a condition in which your blood doesn't have enough healthy red blood cells. Also, your baby may have a low platelet count at birth. Are you at risk for clots? During pregnancy, sometimes platelet levels can become too low or too high. Sepsis and preeclampsia can both cause high platelet volume with low platelet count. This can help prevent serious bleeding during delivery. If you have any symptoms, please contact your provider. Thanks for your question! Platelet counts below 80,000 per cubic millimeter occurred in 13 of the 24 women (54.2%) who had immune thrombocytopenic purpura. It can lead to serious blood and liver problems. Test results can also help find out what type of platelet disorder you have. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Newly made platelets are larger than older platelets, so a high number may signal that your bone marrow's making a lot of new platelets. (Funded by the National Heart, Lung, and Blood Institute.). Reese JA, Peck JD, McIntosh JJ, Vesely SK, George JN. Delivering the fetus early may also be recommended. Your healthcare provider may give you medicine to induce labor. Signs of HELLP syndrome include: To diagnose HELLP syndrome, your healthcare provider will ask you about physical changes such as: Often, blood pressure can be elevated and there can be proteinuria but there doesnt have to be. If you have severe symptoms such as heavy bleeding or seizures, call 911 or go to your nearest emergency department. Leukemia and Lymphoma Society. A total of 59 women (2.3%) had platelet counts below 100,000 per cubic millimeter and 31 women had platelet counts below 80,000 per cubic millimeter during pregnancy, at the time of delivery, or both, which represented a higher incidence of low platelet counts than the incidence among women who had uncomplicated pregnancies (P<0.001). P ractice bulletin no. Blood clots or bleeding may cause the following complications: Getting routine medical care during your pregnancy can help you avoid or manage these complications. Placental abruption, where the placenta separates prematurely from the uterine wall, is also a possible complication of thrombocytosis, according to the Mayo Clinic. HELLP syndrome is a pregnancy complication. HELLP syndrome is a rare pregnancy complication. Learn how we can help Answered Jan 09, 2022 Thank 1 thank Dr. Silviu Pasniciuc answered Copyright 2023 Leaf Group Ltd., all rights reserved. Platelet counts of less than 150,000 per cubic millimeter during uncomplicated pregnancies are described as gestational thrombocytopenia if no alternative cause is identified. Rose SR, Petersen NJ, Gardner TJ, Hamill RJ, Trautner BW. Less commonly, when the high platelet count has no apparent underlying condition as a cause, the disorder is called primary thrombocythemia or essential thrombocythemia. In certain cases, increased platelet count can give rise to serious complications as a result of unexplained blood clotting. Cancer can cause secondary thrombocytosis, which may be one of the first signs of certain types of cancer. In most cases, you will not need any treatment for platelet disorders during pregnancy. Thrombocytopenia, defined as a platelet count 26 000 women suggest that its prevalence at the end of pregnancy is between 6.6% and 11.6%. Some platelet-lowering medications, such as anagrelide, busulfan and hydroxyurea, is embryo-toxic and should not be used in pregnancy. But when that count drops abnormally low, there are several potential causes. 8600 Rockville Pike 2010;27(5):413-9. doi:10.3109/08880011003739455, Oida T, Kano H, Mimatsu K, et al. A high platelet count, or thrombocytosis, can be caused by underlying conditions that are generally easy to manage. Biomed Res Int. 6 Dilution of platelets by the increased plasma volume that occurs during pregnancy16 is an apparent mechanism. Our objectives with respect to women who had uncomplicated pregnancies were to learn the course of platelet counts throughout pregnancy, the potential severity of gestational thrombocytopenia, and the risk for recurrence of gestational thrombocytopenia with a subsequent pregnancy. The rate of decrease in platelet counts was similar in the two groups until the third trimester, when the decrease occurred at a greater rate in the women with pregnancy-related complications than in the women with uncomplicated pregnancies (Fig. Throughout their pregnancies and deliveries, 59 women (2.3%) with pregnancy-related complications had a platelet count below 100,000 per cubic millimeter, and 31 (1.2%) had a platelet count below 80,000 per cubic millimeter. A reactive high platelet level could be due to a whole range of causes which include: -Acute bleeding and blood loss -Allergic reactions -Cancer -Chronic kidney failure or another kidney disorder -Exercise -Heart attack -Coronary artery bypass -Infections, including tuberculosis -Iron deficiency -Vitamin deficiency -Removal of spleen -Hemolytic However, certain serious conditions, such as HELLP syndrome and preeclampsia, can cause very low platelet counts. 6 A very high platelet count can cause blood clots that can block blood flow to the embryo or fetus, while low platelet counts can cause bleeding. A novel approach to the assessment of variations in the human platelet count. But it also can develop in the first week after childbirth (postpartum preeclampsia). Treatment for elevated platelet levels will vary depending on the underlying cause. The Pregnancy-Platelet Connection During pregnancy, your body makes more blood plasma. Of these women, 4568 had uncomplicated pregnancies, 2586 had pregnancy-related complications, and 197 had preexisting disorders associated with thrombocytopenia. 155 - 409. If you have serious complications, you may have to deliver your baby early. To search for potential alternative causes of platelet counts less than 80,000 per cubic millimeter in women who had uncomplicated pregnancies, we reviewed the womans entire set of medical records from Oklahoma University Medical Center. Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community. The alternative causes for the thrombocytopenia that were identified in the other 7 women were immune thrombocytopenic purpura (2 women), pseudothrombocytopenia due to in vitro platelet clumping (2 women), error in measurement of platelet count (2 women), and hereditary thrombocytopenia (1 woman). Among women who had one of the other three disorders, 1.4 to 6.0% had platelet counts below 80,000 per cubic millimeter (Table S4B in the Supplementary Appendix). Or you may need to deliver with a cesarean birth (C-section). Your provider will keep an eye on your blood pressure and other vital signs to catch problems like HELLP early.
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