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borderline platelet count in early 2nd trimester

post #1 of 3
Thread Starter 

Any thoughts on bloodwork showing low-ish platelets at 16 weeks in a healthy G1P0? Platelets are 153 (with reference range listed as 150-400 10*9/L. Platelets were 228 in January and 212 in May (both pre-pregnancy draws). 

 

I've seen thrombocytopenia arising in later pregnancy but can't recall such a low value so early on in pregnancy. Would love to hear any dietary recommendations, things to watch out for, when to test again. 

 

In the interest of full disclosure, the client is me! 

 

Thanks!

 

post #2 of 3

I'd be interested in hearing your thoughts on this topic, mama/midwife.  How would you handle this if the client was not you?  And then...what do you feel intuitively about your platelet count?  Are you worried, or is your academic midwifery background telling you to worry?  There is no judgement at all in these questions.  I have simply always been interested in platelet count during pregnancy because there is so little literature out there on the topic.

 

As a student, I have worked with two mamas with very low platelets.  At term, one mama was in the 120's (and had dropped from the 200's) and the other mama's count was 82 (had dropped from 145 in the beginning of her pregnancy).  Both were concurrently seeing a hematologist who was "not worried".  He put them on multiple B-12 injections in the last trimester, and both mamas' platelet counts continued to drop during their pregnancy.  Increased folic acid through both diet and supplements were recommended, both clients attested to supplementing, and still both clients' platelets continued to drop.

 

The midwives prepared for hemorrhage with pit, methergine, and cytotec.  One mama had a birth center birth, the other mama birthed at home.  I believe the homebirthing mama received prophylactic pit, but I do not remember for sure.  Neither hemorrhaged, so it is difficult to say whether or not the hypothetical hemorrhage would have been devastating due to the low platelet count.

 

So basically, in my limited experience, in mamas with falling platelet counts, nothing works to bring the numbers back up or to stall the dropping count but this may not necessarily lead to adverse birth outcomes.

 

I hope more midwives with more experience join in this topic!  And good luck with your research, mama! innocent.gif

post #3 of 3

I think the above poster had some good points for you.  The platelet level you stated is still *normal* so at this point I would do nothing.  I would want to recheck the level with the third trimester CBC around 28 weeks.  If it was lower but not dramatic (125-140s -ish) I would do monthly rechecks unless it started dropping dramatically then weekly or every other week.  I work in a pretty big practice and we see this somewhat commonly.  Anesthesia won't do an epidural with less than 100K and we like to have a level in labor just to know where we stand even if mom doesn't plan regional anesthesia (lots of our moms don't).  In theory you want to be prepared for a PPH at less than 100K but I've not seen this be a problem in practice.  I had a mama who was diagnosed with HELLP syndrome very late in her labor, platelets were 40K and she was on mag as well...no bleeding problems though we were certainly prepared for it!  What I've been told by our docs is that we wouldn't really do anything differently in pg for a mom with pregnancy induced thrombocytopenia unless her levels got to the point where there is actually a bleeding risk (50-60K).  In that case steroids are given to boost the platelet levels but it only works short term and we try to avoid doing it over and over.  This can be done at term to boost a mama up just before labor but usually isn't necessary.

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