Immune Thrombocytopenia and Pregnancy

Women who have immune thrombocytopenia (ITP) during pregnancy may not exhibit any symptoms or may have a history of epistaxis or gingival bleeding, petechiae, and bleeding into the mucous membranes, or menometrorrhagia or menorrhagia before becoming pregnant.

Book an appointment with your gynaecologist right away if you experience any of these symptoms

Autoreactive B cells are proliferated and differentiated by splenic T follicular helper cells, generating antiplatelet autoantibodies that help macrophages more easily phagocytose platelets, primarily in the spleen. Both the mother and the child may be impacted by these autoantibodies because they can cross the placenta.

There is no test to distinguish between gestational and immune-mediated thrombocytopenia. As a result, a personal history of bleeding, a low platelet count prior to pregnancy, and/or a family history that excludes hereditary thrombocytopenia (HA) are used to make the diagnosis of immune thrombocytopenia (ITP).

The following are the preliminary investigations for thrombocytopenia in pregnancy:

Complete blood cell count (CBC)
Reticulocyte count
Peripheral smear examination
Coagulation test
Liver function tests
Autoimmune disease screening
Levels of vitamin B12, zinc, and folate
In some cases, a bone marrow biopsy may be required
In the first and second trimesters, pregnant women with ITP should have monthly check-ups; after 28 weeks, every two weeks; and after 36 weeks, weekly.

Glucocorticoids, such as dexamethasone or prednisone, are both useful as first treatments.
Women who do not react to prednisone may benefit from intravenous immunoglobulin (IVIG).
The clinical care of ITP associated with pregnancy is a challenging endeavour that necessitates tight coordination between the obstetrician, haematologist, and anaesthetist.