Thrombocytopenia in Pregnancy: A Narrative Review

Thrombocytopenia, characterized by a platelet count less than 150 × 10^9/L, is a frequently encountered hematologic abnormality in pregnancy, observed in approximately 7-12% of all pregnant individuals. While gestational thrombocytopenia is the most common cause and is often benign, other underlying causes, such as immune thrombocytopenia (ITP), pre-eclampsia-related conditions like HELLP syndrome, and thrombotic microangiopathies (e.g., TTP, HUS, AFLP), may carry significant maternal and fetal risks. The current review aims to provide a comprehensive overview of thrombocytopenia during pregnancy, with emphasis on its differential diagnosis, clinical presentation, diagnostic workup, and management strategies. Particular focus is placed on conditions requiring urgent intervention, including thrombotic microangiopathies. We conducted a narrative review of published literature, consensus guidelines, and registry data. Emphasis was placed on clinical applicability, trimester-wise drug safety, and proposed diagnostic algorithms. Tables summarize platelet thresholds for delivery, transfusion indications, and drug safety profiles. The review reiterates that the causes of thrombocytopenia during pregnancy range from benign to potentially life-threatening. Gestational thrombocytopenia remains the most common etiology, typically requiring no intervention. In contrast, ITP and thrombotic microangiopathies often necessitate immunosuppressive therapy or plasma exchange. Differentiation is aided by clinical history, timing of onset, and accompanying systemic features. This review helps conclude that early recognition, appropriate triaging, and multidisciplinary coordination are essential to improve maternal and neonatal outcomes. Wherever feasible, therapeutic decisions must be individualized, balancing maternal benefit with fetal safety. Tables and figures should guide the clinician in applying evidence-based decisions across diverse clinical scenarios.