Thrombocytopenia

Question 1

Causes of thrombocytopenia

Answer 1

Most common causes gestational thrombocytopenia
HELLP syndrome
primary immune thrombocytopenia
Secondary immune thrombocytopenia caused by antiphospholipid antibody syndrome/lupus, infections such as HIV hepatitis CMV, drug-induced
Systemic conditions such as DIC, TTP/HUS, Splenic quest ration bone marrow disorders, nutritional deficiencies

Question 2

Can I TP cause neonatal thrombocytopenia

Answer 2

Yes, Maternal IgG antibodies can cross the placenta. 1/4 of infants born to women with ITP have plt <150k

Question 3

Fetal-neonatal allo immune thrombocytopenia

Cause

Sxs

Answer 3

The platelet equivalent of hemolytic Disease of the newborn
Results from maternal allo immunization to fetal platelet antigen
Profound thrombocytopenia with an hours after birth, manifest as generalized petechiae, intracranial hemorrhage. Intracranial hemorrhage can also occur in utero
Recurrence risk is high

Question 4

Maternal work up for thrombocytopenia

Answer 4

Review current medications
CBC
Peripheral blood smear
If late third trimester, consider preeclampsia TTP, HUS, acute fatty liver or DIC

Question 5

When is platelet transfusion needed

Answer 5

For platelet count less than 50,000 if surgery planned

<30000 dt spontaneous bleeding risk

Question 6

What is the treatment for ITP

Answer 6

The steroids or IV I G
Prednisone add a dose of .5 to 2 mg per kilogram daily is recommended as the initial treatment
Steroids should be given for 21 days than tapered
Initial response should occur within 4 to 14 days
If that doesn’t work, go to IV I G
Splenectomy for patients who fail first line treatment

Question 7

What is the appropriate mode of delivery

Answer 7

C-section. Or a vaginal delivery.
No evidence of C-section improves neonatal outcomes As long as fetal platelet count is greater than 50,000. If it is below 50,000 C-section is recommended