How would you manage presumed gestational thrombocytopenia with moderate thrombocytopenia for delivery planning?

Platelet counts 50-80k in third trimester, with no obvious other underlying etiology on work up (vWD, TMA, no hx ITP), and no history of bleeding. How do you approach need for potential procedures, neuraxial anesthesia, cesarean section with this platelet count? Would you consider empiric ITP therapy with steroids?

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For pregnant patients with platelets <100, would you trial empiric steroids/IVIG for possible ITP?

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Hematology · The Mass General Porphyria Center

Answered on · Updated on

Thanks for this question. First and foremost, it's critical to rule out a placental-mediated complication such as pre-eclampsia and HELLP, and to evaluate for other more nefarious causes of thrombocytopenia (TTP, aHUS, etc., though of course rare). While a diagnosis of exclusion, gestational thrombo...

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