Thrombocytopenia in pregnancy

Thrombocytopenia is quite common during pregnancy.

Thrombocytopenia is a disease in which the percentage of platelets in the blood decreases. Platelets are a type of megakaryocytic cytoplasm that does not contain a nucleus. Platelets also participate in localized inflammatory processes. The platelet membrane contains special molecules that recognize damage in the vessels. Thus, the platelet is introduced into the wall of the damaged vessel and acts as a living patch. However, the main role of platelets is still to stop bleeding. Platelets form a platelet plug, produce factors that narrow the vascular walls, and activate a system that affects the formation of a fibrin clot. Platelets are produced by red bone marrow cells; under unfavorable factors, the production process is inhibited and thrombocytopenia occurs - low blood clotting. Visually, a lack of platelets is manifested in the form of diapedetic rash - minor bleeding. Thrombocytopenia during pregnancy is dangerous because there is a very high probability of hemorrhages in organs and the intracranial cavity. There is also a risk of thrombocytopenia developing in the fetus. Therefore, pregnant women need to be especially responsible when taking blood tests and assess the possible risk in the absence of treatment.

Causes of thrombocytopenia during pregnancy

The causes of thrombocytopenia during pregnancy are different, it is a common pathology. The main causes of thrombocytopenia are:

• decreased platelet viability due to hormonal imbalance;
• an increase in blood volume and, because of this, a decrease in the percentage of platelets;
• poor nutrition associated with insufficient intake of essential vitamins, namely folates, vitamin B12;
• neuropathy in pregnant women, preeclampsia, eclampsia;
• infectious diseases of viral nature;
• development of autoimmune thrombocytopenia during activation of the immune system in pregnant women;
• presence of allergies;
• obstetric bleeding (during placental abruption);
• in case of intrauterine fetal death;
• various intoxications and side effects after taking antibacterial drugs.

A physiological decrease in the percentage of platelets in the blood (100*109) is also possible. It does not require specific treatment, only blood test monitoring is indicated. If a fact of pathological decrease in platelets is recorded, then urgent elimination of the cause and special individual treatment are required. These measures are necessary to prevent dangerous pathologies during pregnancy and childbirth.

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Symptoms of thrombocytopenia during pregnancy

Symptoms of thrombocytopenia during pregnancy have a more vivid and varied description than in other patients. For pregnant women, the following are typical:

• The appearance of small hematomas on the skin after touching, sometimes even without external influence on them.
• Various bleedings - nosebleeds, gum bleeding. But this symptom cannot be called strictly specific, many pregnant women develop gum inflammation due to vitamin deficiency.
• Bleeding from the gastrointestinal tract, bleeding from anal fissures and from hemorrhoidal nodes in hemorrhoids is also recorded.
• Bleeding from the uterine cavity not associated with the menstrual cycle.
• The appearance of small pinpoint hemorrhages affecting the anterior surface of the body and limbs.

Symptoms of thrombocytopenia during pregnancy indicate very serious disorders of the hematopoiesis process. This is very dangerous both during pregnancy and during childbirth. Of particular danger is the high probability of bleeding, which can cost the life of the pregnant woman herself, and lead to the development of thrombocytopenia in the newborn. During childbirth, women with thrombocytopenia are prohibited from performing any actions accompanied by physical impact on the child, as this can cause bleeding into the intracranial cavity.

Secondary thrombocytopenia in pregnancy

Secondary thrombocytopenia during pregnancy is most often diagnosed in the second trimester of pregnancy and can develop in several cases. Basically, this type of thrombocytopenia develops due to irradiation of the body (radiation sickness), poisoning with toxic compounds (heavy metal salts, gasoline derivatives, alcohol), thrombocytopenia can also form as a symptom of a disease such as uremia. In addition, secondary thrombocytopenia during pregnancy develops with toxic damage to the bone marrow and inhibition of megakaryocyte growth, with the effect of bacterial poisons on the bone marrow, and the effect of viruses (chickenpox, scarlet fever, measles, infectious mononucleosis, etc.) is especially destructive. Cytostatic drugs also reduce the level of platelets, as they are aimed at inhibiting the growth of megakaryocytes. Thrombocytopenia also develops in leukemia, when the bone marrow degenerates and is replaced by stroma, and splenomegaly – excessive hypertrophy of the spleen due to liver dysfunction or if the splenic vein is obstructed.

Secondary thrombocytopenia during pregnancy is especially dangerous for the child, since antibodies with the blood flow easily penetrate through the umbilical cord into its body and this leads to the destruction of platelets in the fetus. But with timely diagnosis and special treatment, the prognosis for the mother and child is favorable.

Diagnosis of thrombocytopenia during pregnancy

Diagnosis of thrombocytopenia during pregnancy primarily includes laboratory diagnostic methods. Thus, diagnosis of thrombocytopenia consists of several stages:

• Medical examination.
• Conducting blood tests (biochemical and clinical).
• Detection of blood clotting factor.
• A blood test that shows whether autoantibodies are being produced against platelets.
• Carrying out a bone marrow aspiration biopsy.

Blood analysis is the most convenient way to assess the percentage ratio of leukocytes, erythrocytes and thrombocytes in the blood. Urine analysis is also performed to detect hemosiderin.

If during a medical examination of a pregnant woman, symptoms of thrombocytopenia are visually evident - a small-point rash on the skin, small hemorrhages in the oral mucosa, conjunctiva, then this is a reason to conduct not only a blood test, but also to do a bone marrow puncture. If a large number of megakaryocytes predominate in the bone marrow smear, this indicates that platelets in the body are destroyed or deposited in the spleen.

Confirmation of thrombocytopenia requires a conclusion from a hematologist about the nature of the disease and its pathogenesis. Specific treatment is then prescribed as soon as possible, which gives a favorable prognosis for both the mother and the child.

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Treatment of thrombocytopenia during pregnancy

Treatment of thrombocytopenia during pregnancy begins as soon as possible after confirmation of the suspected analysis. Thrombocytopenia usually develops in the third trimester of pregnancy, and at this stage there is a high probability of intrauterine destruction of platelets in the fetus, due to the transfer of maternal antibodies through the umbilical cord into the fetal bloodstream.

Thrombocytopenia with a platelet percentage of less than 20-40*109 per l requires urgent treatment. It is also important not only to influence the cause of the platelet deficiency, but also to normalize hemostasis. In such cases, the basis of treatment is the administration of glucocorticosteroids (prednisolone, dexamethasone, etc.). They are prescribed systemically, in a short course, and the dosage is gradually reduced until there is a pronounced positive result.

If the introduction of glucocorticosteroid does not give the desired result, immunoglobulins are administered intravenously. They are prescribed at one time, but according to the following system: 3-4 times during pregnancy, during labor and after labor. In particularly rare and complex cases, platelet mass is prescribed intravenously.

If all available conservative treatment methods do not give results, during the second trimester of pregnancy the woman undergoes an operation to remove the spleen, and in order to eliminate all the risks of abdominal surgery, the removal is performed laparoscopically. The prognosis of conservative treatment and the postoperative period for the child and fetus is positive.

Prevention of thrombocytopenia during pregnancy

Prevention of thrombocytopenia during pregnancy comes down to eliminating factors that provoke dysfunction of the woman's immune system. This is isolation from sick people or vaccination before pregnancy against measles, rubella, chickenpox, flu and acute respiratory viral infections; protection from contact with sick people and carriers of cytomegalovirus infection and other childhood infections. Viruses are especially dangerous for a pregnant woman, as they release toxins that inhibit the functioning of the bone marrow, as a result of which the percentage of platelet production decreases and thrombocytopenia develops.

Also, if pregnancy is confirmed, it is necessary to refrain from vaccinations and taking certain medications, namely:

• antitumor;
• estrogens;
• thiazide diuretics;
• alcohol-containing drugs;
• quinidine;
• heparin;
• sulfonamides;
• aspirin;
• other anticoagulants and antiplatelet agents.

It is also necessary to protect yourself as much as possible from exposure to chemical toxins and radiation.

It is necessary to consume all the necessary vitamins and food supplements, which will have a positive effect on the immune system and the health of the fetus. Also, in the early stages of pregnancy, a consultation with a hematologist and geneticist is indicated, especially if there are cases of hereditary thrombocytopenia in the family.

Prognosis of thrombocytopenia in pregnancy

The prognosis for thrombocytopenia during pregnancy is generally favorable. Thrombocytopenia in pregnant women occurs in 1-2 percent of cases in the last trimester. In more than half of the cases, this pathology is hormonal in nature, that is, it is associated with changes in the body that are natural for pregnancy. A lack of platelets with indicators above 20-40 * 109 per l does not require specific treatment. But such a pathology as immune thrombocytopenia is dangerous for the fetus. Antibodies, entering the fetus's bloodstream through the umbilical cord with the mother's blood flow, cause the death of platelets. If thrombocytopenia is confirmed in the fetus, any obstetric methods and operations during childbirth are prohibited, since this is dangerous for the fetus and can provoke intracranial hemorrhage.

In general, labor with moderate thrombocytopenia is conducted conservatively. If the treatment of thrombocytopenia in a pregnant woman has not yielded results or the condition has begun to deteriorate sharply (hemorrhages have become more frequent, anemia is progressing), then the question of early delivery by cesarean section is raised. This will protect the fetus from injury during labor and will make it possible to control blood loss during labor without harm to the mother and fetus.

In acute thrombocytopenia, accompanied by massive bleeding, hemorrhages into the cranial cavity, pregnancy is not allowed. But if pregnancy has already occurred, termination is contraindicated, as it can threaten the woman's life.