The presentation and management of platelet disorders in pregnancy

Thrombocytopenia, defined as a platelet count less than 150 000 per microlitre, occurs in 7%-12% of all pregnancies. Apart from anaemia, it is the most common haematological disorder in pregnancy. Despite its frequent occurrence, thrombocytopenia often leads to difficulties of diagnosis and management in pregnancy. Typically, a pregnant woman will have platelet counts of 150 000 to 450 000 per microlitre and platelet counts may be slightly lower than those of healthy, non-pregnant controls. Approximately, 8% of pregnant women will develop mild thrombocytopenia (100 000-150 000 per microlitre) and while 65% of these women will have no underlying pathology, all pregnant women with platelet counts of less than 100 000 per microlitre should undergo further clinical and laboratory assessment. Thrombocytopenia in pregnancy occurs as a result of multiple distinct conditions, we present four cases of thrombocytopenia in pregnancy encountered in our unit over a 12-month period. These include gestational thrombocytopenia, immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP) and thrombocytopenia absent radius (TAR) syndrome. The literature review of these cases highlights the significance of identification, understanding pathophysiology and a multidisciplinary approach to these conditions. We refresh knowledge on these conditions and emphasise the importance of thrombocytopenia in pregnancy.