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Presentation Details
| Thrombocytopenia in pregnancy: A 5-year analysis of characteristics and practices from a single U.S.institution Mackenzie Lemieux1, Ming Lim2. 1Division of Internal Medicine, University of Utah, Salt Lake City, UT, USA.22. Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA |
Abstract
Background: Thrombocytopenia is the second most common hematologic diagnosis in pregnancy and can have serious consequences to both pregnant individual and fetus. Given that less than 1% of pregnancies record moderate to severe thrombocytopenia (platelet count <100 x 109/L), the optimal timing and management of these pregnancies remain poorly defined leading to variable practice patterns and outcomes. Objectives: Here, we sought to characterize the cause, presentation, and management of pregnant individuals with moderate to severe thrombocytopenia over a five-year period (01/01/2018-12/31/2022). Methods: We conducted a retrospective review of 322 pregnant individuals who delivered at the University of Utah with a documented platelet count of <100 x 109/L from antepartum to the hospital discharge date postpartum. Graphing and analysis were conducted in GraphPad Prism 10. Results: Gestational thrombocytopenia (gTCP) was the most common cause of thrombocytopenia (32%, n=105) (Figure 1A). Prevalence of immune thrombocytopenia (ITP) was 10.8% (n=35). The average platelet count of individuals with gTCP (mean=104, median=101, range:38-149) was greater than that for ITP (mean=82, median=85, range:6-148). The majority of individuals (67%) were diagnosed with moderate to severe thrombocytopenia in the third trimester (Figure 1B). Institutional practices for moderate to severe thrombocytopenia: Overall, 107 individuals had a platelet count <70 x 109/L at any point during their pregnancy; of which 68% received neuraxial anesthesia at time of delivery. Twenty-two individuals had a platelet count <70 x 109/L at time of delivery; all except one did not receive neuraxial anesthesia. This one individual received neuraxial anesthesia prior to her platelet count of 69 x 109/L being resulted. Of the 21 individuals with platelet count <70 x 109/L who did not receive neuraxial anesthesia, 11 individuals had HELLP, one had gTCP, 4 had ITP, 2 had coagulopathy, and one had aplastic anemia.
Individuals with immune thrombocytopenia: There were 35 individuals with ITP (median platelet nadir = 66 x 109/L, range: 6 – 99). Twenty-three individuals received a hematology consult of which 20 received ITP treatment including steroids +/- IVIG due to a platelet count <70 x 109/L. Eighteen individuals required treatment to enable safe neuraxial anesthesia placement while 2 required treatment for epidural removal. Only individuals with a hematology consult received treatment. Regardless of consultation status, 25 individuals with ITP received neuraxial anesthesia; 11 required ITP treatment while 13 did not (Table 1). Conclusions: We highlight the real-world distribution of causes and management patterns of moderate to severe thrombocytopenia in pregnancy at a tertiary care center. gTCP remains the most common cause while ITP is the 5th most common. Clinicians followed society recommendations and pregnant individuals with platelet counts <70 x 109/L did not receive neuraxial anesthesia. Early involvement of hematology to assist in diagnosis of ITP and treatment guidance can be helpful in preventing epidural ineligibility at the time of delivery. Involvement of hematology can also help in morbidity prevention for future pregnancies in patients with known ITP.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Individuals with immune thrombocytopenia: There were 35 individuals with ITP (median platelet nadir = 66 x 109/L, range: 6 – 99). Twenty-three individuals received a hematology consult of which 20 received ITP treatment including steroids +/- IVIG due to a platelet count <70 x 109/L. Eighteen individuals required treatment to enable safe neuraxial anesthesia placement while 2 required treatment for epidural removal. Only individuals with a hematology consult received treatment. Regardless of consultation status, 25 individuals with ITP received neuraxial anesthesia; 11 required ITP treatment while 13 did not (Table 1). Conclusions: We highlight the real-world distribution of causes and management patterns of moderate to severe thrombocytopenia in pregnancy at a tertiary care center. gTCP remains the most common cause while ITP is the 5th most common. Clinicians followed society recommendations and pregnant individuals with platelet counts <70 x 109/L did not receive neuraxial anesthesia. Early involvement of hematology to assist in diagnosis of ITP and treatment guidance can be helpful in preventing epidural ineligibility at the time of delivery. Involvement of hematology can also help in morbidity prevention for future pregnancies in patients with known ITP.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.