Thrombocytopenia during pregnancy

Platelets have a very important role in bleeding and bleeding prevention. For women during pregnancy, reducing the number or function of platelets should be taken into account, because the risk of bleeding may occur and especially during childbirth.

Thrombocytopenia may occur due to 3 main causes: reduced ability to create platelets in the marrow; increased platelet destruction in the body; Increases abnormal platelet consumption. This article addresses common and often confused glomerular syndrome in obstetrics.

For pathological thrombocytopenia, the most noticeable problem is thrombocytopenia due to immune factors. Autoimmune thrombocytopenia can be seen in: autoimmune thrombocytopenia (ITP - Idiopathic Thrombocytopenic Purpura ), lupus erythematosus, antiphospholipid autoimmune syndrome.

Chronic ITP is common in women of childbearing age, so it can also be seen in pregnant women. The fetus or newborn of these mothers is also likely to have symptomatic or asymptomatic thrombocytopenia because anti-platelet antibodies can be transmitted through the baby through the placenta.

The most common treatment for pregnant women with ITP as well as other autoimmune thrombocytopenia syndromes are: corticosteroids, intravenous immunoglobulin (IVIG) and splenectomy.

A major limitation in corticosteroid treatment is the severe side effects for both mother and fetus such as hyperglycemia, hypertension, osteoporosis, immunosuppression and birth defects. Because the drug is incapable of healing, use it only when absolutely necessary to prevent bleeding.

IVIG infusion is very expensive and can temporarily increase platelet counts for about 75% of patients. IVIG can cause a strong allergic reaction (headache due to reactive meningitis) and is also indicated to prevent bleeding in necessary cases.

Splenectomy is indicated for women with ITP with signs of bleeding and a high risk of bleeding after other treatments have not yielded the desired results. But we should also know that surgeries during pregnancy can cause great harm to pregnant women and their babies, especially: heavy bleeding, miscarriage, premature birth .

With lupus erythematosus and anti- phospholipid antibody syndrome (also occurs in about 30-40% of patients with lupus erythematosus), thrombocytopenia may be seen in about 2% of patients. In particular, anti- phospholipid antibody syndrome is also capable of causing blood clots, vascular occlusion leading to necrosis. The treatment of thrombocytopenia in these cases is basically no different from the case of ITP in pregnant women.

In addition to immune mechanisms, thrombocytopenia syndrome in pregnant women is also found in microangiopathic processes such as:

- Syndrome of homelysis , with common symptoms such as epigastric pain, severe fatigue, nausea, vomiting, headache, fever, hypertension, edema and hepatomegaly. Blood tests showed thrombocytopenia, increased bilirubin and increased AST. Damage to the vascular wall leading to precipitation of platelets and stasis of fibrin has led to the consumption and destruction of blood cells.

Hemolytic syndrome can lead to some very serious consequences for both pregnant women and the fetus such as scattered coagulation, placental flaking, acute renal failure and respiratory failure. The death rate for pregnant women can be up to 30% and for the fetus nearly 20%. Treatment by transfusion or replacement of plasma (plasma) and asprin in small doses has the potential to stabilize the health of pregnant women and the fetus, but termination of pregnancy is the most optimal method if the fetus is at age. over 34 weeks or in the case of threats to the life of pregnant women and their babies.

- toxemia of pregnancy syndrome is usually divided into two stages: pre-eclampsia and eclampsia with typical symptoms: edema, increased proteinuria and hypertension. Thrombocytopenia may occur for about 15-20% of pregnant women who become pregnant.

- TTP syndrome ( Thrombitic Thrombocytopenic Purpura ) with symptoms: hemolysis, thrombocytopenia, neurological disorders, fever and kidney damage.

HUS ( Hemolytic Uremic Syndrome ) with typical symptoms: peripheral circulatory disorders caused by thrombosis, thrombocytopenia and acute renal failure.

With these two syndromes, plasma infusion or plasma filtration ( plasmapheresis) is an optimal treatment that can reduce death and sequelae for both pregnant women and their babies.

In addition to the two pathological groups as mentioned, a number of pregnancy disorders such as amniotic embolism, placental placenta, uterine rupture . may lead to scattered blood clots and thrombocytopenia. . In these cases, in addition to appropriate obstetric treatments, platelet transfusion may be necessary if the risk of bleeding appears.

In summary, understanding the causes and mechanisms of thrombocytopenia in pregnancy, both physiological and pathological cases will help us to promptly diagnose and respond effectively and properly. management to protect the health and life of pregnant women and their babies.

TS.BS. Hoang Xuan Ba