Low platelet count: What does this mean?

My niece is 24 weeks pregnant and was recently taken to the hospital because of headache and fever. She was diagnosed as having a low platelet count. They said her platelet count is 96. What does a low platelet count mean? Also, how would calcium in the placenta affect the baby?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

The term to describe low platelet count is "thrombocytopenia," and this could be a preexisting problem or one induced by the pregnancy. There is a normal moderate decrease in platelets during pregnancy but whenever the count falls below 150,000, care providers become concerned.

"Thrombocytopenia," a lower than normal platelet count, can occur for several reasons. Healthy women can have this just as an incidental finding with no consequences (about 75 percent are of this type). Women with hypertensive disorders of pregnancy can suffer from this (about 20 percent) and some have an immune disorder (about four percent).

In the immune problem, the mother develops antibodies which attack her platelets. You could see this type in someone who has systemic lupus, as well as lymphomas, leukemias or HIV.

In pregnancy-induced hypertension, when the platelets fall below 100,000 this can be an ominous sign. It is part of the sequence of events in HELLP syndrome, which is part of the whole PIH syndrome complicated by (H) hemolyis, (EL) elevated liver enzymes and (LP) low platelets.

Other tests which should be done include a complete blood cell count (CBC), platelet count, an evaluation of a peripheral blood sample, a prothrombin time and an activated partial thromboplastin time.

Normal platelet counts are above 100,000 cubic mm; mild thrombocytopenia involves counts in the 100,000 to 149,000 range, while moderate thrombocytopenia would be 50,000 to 99,000. Your niece's must be about 96,000.

Clients with "gestational thrombocytopenia" in the mild-to-moderate value ranges generally need no treatment, and the baby appears to be at little, if any, risk of being born with profound thrombocytopenia (platelet count of less than 50,000).

If this condition predated the pregnancy, it would be called idiopathicthrombocytopenia (ITP). This is a distinct entity from the gestational type. It occurs in one to three of every 1,000 pregnancies and can cause profound thrombocytopenia in the newborn. Pregnancy does not cause ITP nor change its severity.

Childhood ITP usually follows a viral illness, and the child may have symptoms such as bruising and bleeding. This condition usually disappears over time.

The adult, however, has more subtle symptoms such as mild bleeding and easy bruisability. If she has the type of ITP that could have predated the pregnancy (determined by a specific antibody test), and your doctor feels that her baby may be at risk for low platelets, an ultrasound-guided "cordocentesis" may be recommended. This is a procedure where the baby's umbilical cord is punctured with a small needle and a blood sample is retrieved for analysis. If the baby is suffering from low platelets, an intrauterine transfusion may be indicated.

It could be that she has the gestational form of this condition and, as stated, it generally requires no special therapy. In that case, she should be treated like a normal pregnant client. Only one percent of the gestational thrombocytopenia patients have a maternal platelet count below 100,000. However, it might be a good idea for her to see a perinatologist to get a second opinion.

Calcium deposits on the placenta usually appear later in gestation and can be a sign of premature aging of the placenta. They can be of no consequence, but further ultrasound follow up should be done. Color-doppler flow studies of the maternal-fetal circulation may be indicated as well.

I hope this is gestational thrombocytopenia and she is able to be reassured. It is great that she has someone such as yourself to rely on for support. I wish you and your family the best. Let me know how you are doing.

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