J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Case Report

Volume 5, Number 4, December 2016, pages 142-150

Severe Gestational Thrombocytopenia: A Case Report and Brief Review of the Literature

**Table 1.** Differential Diagnosis of GT and ITP in Pregnancies With New-Onset Thrombocytopenia
Features	Gestational thrombocytopenia (GT)	Immune thrombocytopenia (ITP)
*Diagnosis must be questioned if item was not fulfilled.
Peripheral blood smear examination (PBS)	Isolated TCP, abundant normal megakaryocytes, normal platelets of all generations while other cell-lines are normal*	Isolated TCP, abundant normal megakaryocytes, normal platelets of all generations while other cell-lines are normal*
Diagnosis	Exclusion of other causes of TCP [3]	Exclusion of other causes of TCP especially secondary ITP [3]
Past history	Negative before pregnancy* (except in previous pregnancy)	Mostly positive, but 30% of ITP cases might present for the first time during pregnancy (new-onset).
Timing of diagnosis	Might appear at any trimester but mostly during late second or third trimesters [11]	Can appear at any trimester but typically in early pregnancy [11].
Platelet count trends	Decrease towards full-term if appeared early [24]	Decrease towards full-term in at least 50% of cases [16, 22].
Multifetal pregnancy	Common association [11]	No reports of such predilection.
Postpartum recovery	Usually rapid and necessarily back to normal levels*	Recovery is usually slower and unlikely to normal levels*
Platelet count levels	Usually > 70 × 10⁹/L but can reach lower levels [9]	Variable and can reach very low levels.
Predisposes to obstetric complications	None [10]	None [23].
Maternal bleeding episodes	None reported even with low platelet counts*	Probable. New-onset cases of ITP might have higher rates of bleeding [6].
Neonatal thrombocytopenia	Probable, reported rates (0.1-2%) similar to infants born to non-thrombocytopenic mothers [6, 8] though others reported higher rates [25, 27].	Affects (25%) of cases but cannot be predicted and not related to maternal platelet count or antibodies titers [13].
Neonatal bleeding	None [3] even in newborns with low platelet counts.	Can occur but uncommon [16] with serious bleeding as ICT only 1-2% [26].
Response to steroids or IVIG treatment	No treatment is required. In the very few severe cases who received treatment, no response was elicited [18, 19].	Response as in non-pregnant cases. Thirty to fifty percent of patients might require treatment [16]. More new-onset cases might require therapy [16].
Recurrence in future pregnancies	Probable, but rate is unknown.	Probable, but rate is unknown.

Table 1. Differential Diagnosis of GT and ITP in Pregnancies With New-Onset Thrombocytopenia

Features

Gestational thrombocytopenia (GT)

Immune thrombocytopenia (ITP)

*Diagnosis must be questioned if item was not fulfilled.

Peripheral blood smear examination (PBS)

Isolated TCP, abundant normal megakaryocytes, normal platelets of all generations while other cell-lines are normal*

Diagnosis

Exclusion of other causes of TCP [3]

Exclusion of other causes of TCP especially secondary ITP [3]

Past history

Negative before pregnancy* (except in previous pregnancy)

Mostly positive, but 30% of ITP cases might present for the first time during pregnancy (new-onset).

Timing of diagnosis

Might appear at any trimester but mostly during late second or third trimesters [11]

Can appear at any trimester but typically in early pregnancy [11].

Platelet count trends

Decrease towards full-term if appeared early [24]

Decrease towards full-term in at least 50% of cases [16, 22].

Multifetal pregnancy

Common association [11]

No reports of such predilection.

Postpartum recovery

Usually rapid and necessarily back to normal levels*

Recovery is usually slower and unlikely to normal levels*

Platelet count levels

Usually > 70 × 10⁹/L but can reach lower levels [9]

Variable and can reach very low levels.

Predisposes to obstetric complications

None [10]

None [23].

Maternal bleeding episodes

None reported even with low platelet counts*

Probable. New-onset cases of ITP might have higher rates of bleeding [6].

Neonatal thrombocytopenia

Probable, reported rates (0.1-2%) similar to infants born to non-thrombocytopenic mothers [6, 8] though others reported higher rates [25, 27].

Affects (25%) of cases but cannot be predicted and not related to maternal platelet count or antibodies titers [13].

Neonatal bleeding

None [3] even in newborns with low platelet counts.

Can occur but uncommon [16] with serious bleeding as ICT only 1-2% [26].

Response to steroids or IVIG treatment

No treatment is required. In the very few severe cases who received treatment, no response was elicited [18, 19].

Response as in non-pregnant cases. Thirty to fifty percent of patients might require treatment [16]. More new-onset cases might require therapy [16].

Recurrence in future pregnancies

Probable, but rate is unknown.