Immune Thrombocytopenia and Pregnancy Workup

  • Author: Lynnae Millar; Chief Editor: David Chelmow, MD   more...
 
Updated: Jan 10, 2012
 

Laboratory Studies

  • No symptoms, signs, or laboratory tests are diagnostic of ITP in pregnancy.
    • Platelet counts less than 70,000/µL are suspicious for the disorder if no other etiology for thrombocytopenia is identified.[17]
    • Bone marrow aspiration demonstrates normal or increased numbers of megakaryocytes. Guidelines from the American Society of Hematology state that a bone marrow examination is not required in adults aged less than 60 years who have a classic presentation for ITP. However, the bone marrow should be assessed prior to proceeding with splenectomy.
    • Antiplatelet antibodies can be detected in the serum of women with ITP. The direct assay for the measurement of platelet-bound autoantibodies has an estimated sensitivity of 49-66% and an estimated specificity of 78-92%. A negative test does not exclude the diagnosis.[18] Additionally, many women with gestational thrombocytopenia have high levels of circulating platelet-associated immunoglobulin. Therefore, current antiplatelet antibody assays cannot be used to differentiate between ITP and gestational thrombocytopenia.
  • A platelet count less than 150,000/µL is consistent with thrombocytopenia in newborns. Consider NAIT in the differential diagnosis of any significantly thrombocytopenic newborn (platelet count < 50,000/µL) or in newborns with intracranial hemorrhages (platelet count < 100,000/µL) in whom other illnesses commonly associated with thrombocytopenia have been excluded.[16]
    • Platelet antigen typing can determine the genotype of the mother and father of the baby to determine if they are discordant.
    • Test the maternal sera for the presence of a platelet antibody that binds paternal, but not maternal, platelets.
    • A lack of antiplatelet antibody does not exclude the diagnosis of NAIT because, in a number of cases, no antiplatelet antibody could be detected when fetuses were profoundly thrombocytopenic due to NAIT.[7]
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Lynnae Millar  MD, Professor, Chair, Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii

Lynnae Millar is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Wadie F Bahou, MD  Chief, Division of Hematology, Hematology/Oncology Fellowship Director, Professor, Department of Internal Medicine, State University of New York at Stony Brook

Wadie F Bahou, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD  Leo J Dunn Distinguished Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making

Disclosure: Nothing to disclose.

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Immune thrombocytopenia. Nonstress test 1 week before delivery showing a normal reactive fetal heart rate pattern.
Immune thrombocytopenia. Nonstress test 4 days before delivery showing a reactive fetal heart rate with an unusual pseudosinusoidal pattern that lasted 9 minutes.
Immune thrombocytopenia. Neonatal brain at autopsy showing extensive subdural hemorrhage.
Immune thrombocytopenia. Neonatal spine at autopsy showing extensive hemorrhage at base of spine.
Immune thrombocytopenia. An infant born with neonatal lupus syndrome and severe thrombocytopenia. Note extensive bruising and petechiae.
Immune thrombocytopenia. An infant born with a cephalohematoma.
 
 
 
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