Thrombocytopenia in Pregnancy: A 5-Year Analysis of Characteristics and Practices From a Tertiary Academic Center

Moderate-to-severe thrombocytopenia (platelet count < 100 × 10⁹/L) occurs in fewer than 1% of pregnancies, posing management challenges, particularly surrounding eligibility for neuraxial anesthesia. Although recent anesthesia guidelines recommend a platelet threshold ≥ 70 × 10⁹/L, outcomes data applying these recommendations in moderate-to-severe thrombocytopenia remain limited.

We conducted a retrospective study of 306 pregnancy encounters at a tertiary U.S. center (January 2018-December 2022) with ≥ 1 documented platelet count < 100 × 10⁹/L. Etiology, platelet nadir, hematology consultation, treatment patterns, and neuraxial anesthesia (NA) use were assessed from antepartum through postpartum discharge.

Gestational thrombocytopenia (gTCP) was the most common etiology (29%, n = 92). Thrombocytopenia severity differed across etiology, with higher platelet nadirs in gTCP (mean 84, median 88.5 × 10⁹/L) compared with ITP (mean 62, median 66 × 10⁹/L). Overall, 15% of pregnancies received hematology consultation, the majority of which were for individuals with ITP, and 78% underwent NA. Among pregnancies complicated by ITP, 71% received NA. Hematology consultation in ITP was associated with lower platelet nadirs and higher treatment rates.

In this cohort of moderate-to-severe thrombocytopenia, institutional adherence to guideline-recommended platelet thresholds was high and associated with excellent neuraxial safety outcomes. These findings provide real-world support for current anesthesia recommendations in a higher-risk obstetric population.