Your activity: 8 p.v.
< Back

Likelihood that thrombocytopenia in a pregnant woman is due to gestational thrombocytopenia, according to platelet count

Likelihood that thrombocytopenia in a pregnant woman is due to gestational thrombocytopenia, according to platelet count
Platelet count Likelihood of GT
100,000 to 149,000/microL
  • Almost certainly GT (in our cohort of 4568 women with uncomplicated pregnancies, 99% had platelet counts ≥100,000/microL at delivery; among the 450 who were diagnosed with GT, 93% had platelet counts between 100,000 and 149,000/microL).
  • ITP cannot be excluded but is very unlikely.
  • Other diagnoses are also very unlikely.
80,000 to 99,000/microL
  • Probably not GT (in our cohort of 4568 women with uncomplicated pregnancies, only 26 [0.6%] had platelet counts between 80,000 and 99,000/microL at delivery).
  • Other causes of thrombocytopenia should be considered, such as ITP, pseudothrombocytopenia due to platelet clumping, and hereditary thrombocytopenia.
60,000 to 79,000/microL
  • Almost certainly not GT (in our cohort of 4568 women with uncomplicated pregnancies, only 12 [0.3%] had platelet counts between 60,000 and 79,000/microL at any time. Only 5 had GT; 7 had another diagnosis [7 platelet count error; 2 unrecognized ITP; 1 unrecognized hereditary thrombocytopenia]).
  • Almost certainly there is another cause for the thrombocytopenia. If the diagnosis of ITP is considered, no treatment would be required.
<60,000/microL
  • Not GT (none of 450 women with GT in our study had a platelet count <60,000/microL).
  • Another cause for the thrombocytopenia must be identified. Treatment of ITP would be required if the platelet count is <30,000/microL.
The likelihood of GT is based on our observations of routine platelet count testing on 4568 women with uncomplicated pregnancies.[1] Importantly, GT is asymptomatic and not associated with other findings such as hypertension, neurologic abnormalities, impaired renal or hepatic function, microangiopathic hemolysis, or coagulation abnormalities. If these findings are present, the diagnosis of GT cannot be the explanation for thrombocytopenia. Refer to the companion table in UpToDate on non-GT causes of thrombocytopenia in pregnancy.
GT: gestational thrombocytopenia; ITP: immune thrombocytopenia.
Reference:
  1. Reese JA, Peck JD, Deschamps DR, et al. Platelet counts during pregnancy. N Engl J Med 2018; 379:32.
Graphic 118571 Version 2.0